Provider Demographics
NPI:1821089863
Name:CHAO, HANPU (MD)
Entity Type:Individual
Prefix:DR
First Name:HANPU
Middle Name:
Last Name:CHAO
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 1:3 BERLIN ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02170-1801
Mailing Address - Country:US
Mailing Address - Phone:617-472-0601
Mailing Address - Fax:
Practice Address - Street 1:59 CODDINGTON ST
Practice Address - Street 2:SUITE 204
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-4510
Practice Address - Country:US
Practice Address - Phone:617-770-5670
Practice Address - Fax:617-777-1281
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA78222208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3115518Medicaid
MAE64371Medicare UPIN