Provider Demographics
NPI:1356331920
Name:YUAN, QIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:QIAN
Middle Name:
Last Name:YUAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 WASHINGTON STREET
Mailing Address - Street 2:SUITE 466
Mailing Address - City:NEWTON LOWER FALLS
Mailing Address - State:MA
Mailing Address - Zip Code:02462
Mailing Address - Country:US
Mailing Address - Phone:617-969-8989
Mailing Address - Fax:617-928-0178
Practice Address - Street 1:2000 WASHINGTON STREET
Practice Address - Street 2:SUITE 466
Practice Address - City:NEWTON LOWER FALLS
Practice Address - State:MA
Practice Address - Zip Code:02462
Practice Address - Country:US
Practice Address - Phone:617-969-8989
Practice Address - Fax:617-928-0178
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA209229208000000X, 2080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA468584OtherTUFTS HEALTH PLAN
MAJ26557OtherBCBS MA
MA2037751Medicaid
MA2037751Medicaid
MA468584OtherTUFTS HEALTH PLAN
MAJ26557OtherBCBS MA
57567206Medicare PIN