Provider Demographics
NPI:1447209895
Name:XIONG, YUTING (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:YUTING
Middle Name:
Last Name:XIONG
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 SUMMER ST
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-5542
Mailing Address - Country:US
Mailing Address - Phone:203-324-2128
Mailing Address - Fax:203-588-1705
Practice Address - Street 1:970 SUMMER STREET
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5518
Practice Address - Country:US
Practice Address - Phone:203-324-2128
Practice Address - Fax:203-588-1705
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT040627208100000X, 2081P2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTH36135Medicare UPIN