Provider Demographics
NPI:1588623961
Name:CHOU, MARY T (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:T
Last Name:CHOU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:133 BROOKLINE AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-3904
Mailing Address - Country:US
Mailing Address - Phone:617-421-1336
Mailing Address - Fax:617-421-1359
Practice Address - Street 1:133 BROOKLINE AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-3904
Practice Address - Country:US
Practice Address - Phone:617-421-1336
Practice Address - Fax:617-421-1359
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA2107252085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAA52123OtherHARVARD PILGRIM
MD2743351OtherCIGNA
MA2044897Medicaid
MAJ27343OtherBLUE CROSS
MD468852OtherTUFTS
MA0037252OtherNEIGHBORHOOD HEALTH
MAI09665Medicare UPIN
MAJ27343OtherBLUE CROSS