Provider Demographics
NPI:1710208731
Name:TANSKY, JOANNA Y (MD PHD)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:Y
Last Name:TANSKY
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:
Other - First Name:JOANNA
Other - Middle Name:
Other - Last Name:CHIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:492 MASSACHUSETTS AVE
Mailing Address - Street 2:61
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-1150
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 BLOSSOM ST
Practice Address - Street 2:COX LEVEL 3
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2606
Practice Address - Country:US
Practice Address - Phone:617-869-2894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-14
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MA2631652085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program