Provider Demographics
NPI:1720295124
Name:HO, DOREEN TAM (MD)
Entity Type:Individual
Prefix:DR
First Name:DOREEN
Middle Name:TAM
Last Name:HO
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:LAHEY CLINICAL MEDICAL CTR
Mailing Address - Street 2:41 MALL ROAD
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01805-0001
Mailing Address - Country:US
Mailing Address - Phone:781-744-7736
Mailing Address - Fax:
Practice Address - Street 1:LAHEY CLINICAL MEDICAL CTR
Practice Address - Street 2:41 MALL ROAD
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01805-0001
Practice Address - Country:US
Practice Address - Phone:781-744-7736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2013-05-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA2394112084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110085415AMedicaid
MA110085415AMedicaid