Provider Demographics
NPI:1649220955
Name:TIEN, IRENE (MD)
Entity Type:Individual
Prefix:DR
First Name:IRENE
Middle Name:
Last Name:TIEN
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 1:2 CLARENDON ST
Mailing Address - Street 2:APT 702
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-6137
Mailing Address - Country:US
Mailing Address - Phone:617-267-1217
Mailing Address - Fax:617-267-1217
Practice Address - Street 1:91 E CONCORD ST
Practice Address - Street 2:RM 6215
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2644
Practice Address - Country:US
Practice Address - Phone:617-414-4397
Practice Address - Fax:617-414-4393
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA159223207P00000X, 207PP0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Not Answered207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3193233Medicaid
MAG89104Medicare UPIN
MAA29307Medicare ID - Type Unspecified