Provider Demographics
NPI:1467443150
Name:TSO, LI (MD)
Entity Type:Individual
Prefix:DR
First Name:LI
Middle Name:
Last Name:TSO
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Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-6670
Mailing Address - Fax:617-724-6632
Practice Address - Street 1:15 PARKMAN ST
Practice Address - Street 2:BULFINCH MEDICAL GROUP, WANG 535
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-3117
Practice Address - Country:US
Practice Address - Phone:617-724-6640
Practice Address - Fax:617-724-6632
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2014-02-14
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Provider Licenses
StateLicense IDTaxonomies
MA75440207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA727225OtherTUFTS HEALTH PLAN
MA3091058Medicaid
MAJ12245OtherBCBS MA
MA727225OtherTUFTS HEALTH PLAN
F23955Medicare UPIN