Healthcare Provider Details

I. General information

NPI: 1043405400
Provider Name (Legal Business Name): CYNTHIA SUE TUNG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 01/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVE BADER 3
BOSTON MA
02115-5724
US

IV. Provider business mailing address

300 LONGWOOD AVE BADER 3
BOSTON MA
02115-5724
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-7737
  • Fax:
Mailing address:
  • Phone: 617-355-7737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberD0064496
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberD0064496
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberD0064496
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberD0064496
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberD0064496
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: