Provider Demographics
NPI:1780644534
Name:HO, SIMON SIU-MAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SIMON
Middle Name:SIU-MAN
Last Name:HO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1157 HANCOCK ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-4303
Mailing Address - Country:US
Mailing Address - Phone:617-479-3940
Mailing Address - Fax:
Practice Address - Street 1:1157 HANCOCK ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-4303
Practice Address - Country:US
Practice Address - Phone:617-479-3940
Practice Address - Fax:617-479-9827
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2013-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA81534207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3140342Medicaid
MA3140342Medicaid
G05272Medicare UPIN