Provider Demographics
NPI:1396764924
Name:XU, PO PRISCILLA (MD)
Entity type:Individual
Prefix:DR
First Name:PO
Middle Name:PRISCILLA
Last Name:XU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 STRAWBERRY HILL CT
Mailing Address - Street 2:STE L4
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-2532
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 STRAWBERRY HILL CT
Practice Address - Street 2:STE L4
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-2532
Practice Address - Country:US
Practice Address - Phone:203-324-7761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT038587208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1891826053OtherMEDICARE NPI
CT250000279OtherMEDICARE ID-UNSPECIFIED
CT1396764924OtherNPI
CTC03678OtherMEDICARE PTAN
CTC03678OtherMEDICARE PTAN