Provider Demographics
NPI:1811193287
Name:CHENG, ELISA KUO-MIN (MD)
Entity type:Individual
Prefix:DR
First Name:ELISA
Middle Name:KUO-MIN
Last Name:CHENG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:24 DEAN ST
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-3257
Mailing Address - Country:US
Mailing Address - Phone:617-312-3339
Mailing Address - Fax:
Practice Address - Street 1:20 WILLARD ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-4861
Practice Address - Country:US
Practice Address - Phone:617-855-8444
Practice Address - Fax:219-209-5667
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2024-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2292162084P0800X
MA2426992084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA70010000J49320OtherBLUE CROSS BLUE SHIELD