Provider Demographics
NPI:1376532721
Name:SIU-LAI, PANSY (MD)
Entity Type:Individual
Prefix:
First Name:PANSY
Middle Name:
Last Name:SIU-LAI
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 1:578 MAIN ST
Mailing Address - Street 2:HALLMARK HEALTH MEDICAL ASSOCIATES INC
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-3900
Mailing Address - Country:US
Mailing Address - Phone:781-321-3422
Mailing Address - Fax:781-321-1863
Practice Address - Street 1:578 MAIN ST
Practice Address - Street 2:HALLMARK HEALTH MEDICAL ASSOCIATES INC
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-3900
Practice Address - Country:US
Practice Address - Phone:781-321-3422
Practice Address - Fax:781-321-1863
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA80466207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3141969Medicaid
MA3141969Medicaid
G10089Medicare UPIN