Provider Demographics
NPI:1609070267
Name:GAO, CHUANYUN (MD)
Entity Type:Individual
Prefix:DR
First Name:CHUANYUN
Middle Name:
Last Name:GAO
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 1:330 MOUNT AUBURN ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-5502
Mailing Address - Country:US
Mailing Address - Phone:781-314-7600
Mailing Address - Fax:
Practice Address - Street 1:355 WAVERLEY OAKS RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02452-8474
Practice Address - Country:US
Practice Address - Phone:781-314-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP1-0016774207R00000X
MA233406207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
3296030670OtherMYUTMB 3296030670-COMMERCIAL NUMBER