Provider Demographics
NPI:1992192884
Name:CHIN, ADAM TRISTAN (MD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:TRISTAN
Last Name:CHIN
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 1:50 STANIFORD ST STE 600
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2587
Mailing Address - Country:US
Mailing Address - Phone:617-314-2715
Mailing Address - Fax:
Practice Address - Street 1:50 STANIFORD ST STE 600
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2587
Practice Address - Country:US
Practice Address - Phone:617-314-2715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-19
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA264284207W00000X
390200000X
NMRS2019-0044390200000X
MA278639207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program