Provider Demographics
NPI:1720089691
Name:XING, YIGONG POLLY (MD)
Entity Type:Individual
Prefix:
First Name:YIGONG
Middle Name:POLLY
Last Name:XING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:Y. POLLY
Other - Middle Name:
Other - Last Name:XING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:113 WATER ST
Mailing Address - Street 2:SUITE 213
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-3021
Mailing Address - Country:US
Mailing Address - Phone:508-422-2055
Mailing Address - Fax:
Practice Address - Street 1:113 WATER ST
Practice Address - Street 2:SUITE 213
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-3021
Practice Address - Country:US
Practice Address - Phone:508-422-2055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA159077207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110000770AMedicaid
MAA3189701OtherPTAN