Provider Demographics
NPI:1134204878
Name:TSENG, BRIAN S (MD, PHD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:S
Last Name:TSENG
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 ST
Mailing Address - Street 2:ACC 708
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2621
Mailing Address - Country:US
Mailing Address - Phone:617-840-0528
Mailing Address - Fax:617-724-7860
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:ACC 708
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-840-0528
Practice Address - Fax:617-724-7860
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO418282084N0400X
MA2336722084N0402X
CAA737672084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO59757248Medicaid
CO59757248Medicaid
H95731Medicare UPIN