Provider Demographics
NPI:1134802762
Name:QIAN, EDDIE
Entity type:Individual
Prefix:
First Name:EDDIE
Middle Name:
Last Name:QIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 TYLER ST
Mailing Address - Street 2:POSNER HALL DORMITORY, RM # 310 TUFTS UNIVERSITY
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111
Mailing Address - Country:US
Mailing Address - Phone:609-955-4202
Mailing Address - Fax:
Practice Address - Street 1:37 TYLER ST
Practice Address - Street 2:POSNER HALL DORMITORY, RM # 310 TUFTS UNIVERSITY
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111
Practice Address - Country:US
Practice Address - Phone:609-955-4202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program