Provider Demographics
NPI:1902381510
Name:DR. SIMON CHAO, PLLC
Entity Type:Organization
Organization Name:DR. SIMON CHAO, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:SIMON
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-668-4693
Mailing Address - Street 1:33 UPTON ST UNIT 3
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-1609
Mailing Address - Country:US
Mailing Address - Phone:215-668-4693
Mailing Address - Fax:
Practice Address - Street 1:33 UPTON ST UNIT 3
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-1609
Practice Address - Country:US
Practice Address - Phone:215-668-4693
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-28
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204R00000XAllopathic & Osteopathic PhysiciansElectrodiagnostic MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA238724OtherMEDICAL LIC