Provider Demographics
NPI:1619650256
Name:LEAR, BO PENG (PHD)
Entity Type:Individual
Prefix:DR
First Name:BO
Middle Name:PENG
Last Name:LEAR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:BO
Other - Middle Name:
Other - Last Name:PENG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1658 NORMAN WAY APT 2
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-1268
Mailing Address - Country:US
Mailing Address - Phone:240-446-4425
Mailing Address - Fax:
Practice Address - Street 1:1658 NORMAN WAY APT 2
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-1268
Practice Address - Country:US
Practice Address - Phone:240-446-4425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program