Provider Demographics
NPI:1578554580
Name:MAO, JIANREN (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:JIANREN
Middle Name:
Last Name:MAO
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: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:617-726-8810
Mailing Address - Fax:617-726-3441
Practice Address - Street 1:15 PARKMAN ST
Practice Address - Street 2:WAC 324 ANESTHESIA PAIN MANAGEMENT
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-3117
Practice Address - Country:US
Practice Address - Phone:617-726-8810
Practice Address - Fax:617-724-3441
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA159628207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA159628OtherTUFTS HEALTH PLAN
MA3195007Medicaid
MAJ19914OtherBCBS MA
MAA29389Medicare ID - Type Unspecified
MA159628OtherTUFTS HEALTH PLAN