Provider Demographics
NPI:1801181854
Name:TAN, XIAO (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:XIAO
Middle Name:
Last Name:TAN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 FRUIT STREET
Mailing Address - Street 2:BLAKE 4
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114
Mailing Address - Country:US
Mailing Address - Phone:617-724-6006
Mailing Address - Fax:617-724-6832
Practice Address - Street 1:55 FRUIT STREET
Practice Address - Street 2:BLAKE 4
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-643-6361
Practice Address - Fax:617-724-6832
Is Sole Proprietor?:No
Enumeration Date:2011-06-16
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA268832207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology