Provider Demographics
NPI:1275529687
Name:FENG, PAULINE PEI-LING (MD)
Entity Type:Individual
Prefix:
First Name:PAULINE
Middle Name:PEI-LING
Last Name:FENG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 WASHINGTON ST
Mailing Address - Street 2:DEPT OF PEDIATRICS
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-3487
Mailing Address - Country:US
Mailing Address - Phone:617-355-6369
Mailing Address - Fax:
Practice Address - Street 1:800 WASHINGTON ST
Practice Address - Street 2:DEPT OF PEDIATRICS
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-3487
Practice Address - Country:US
Practice Address - Phone:781-769-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA204391208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3207391Medicaid
MAA30803Medicare ID - Type Unspecified
MA3207391Medicaid