Healthcare Provider Details

I. General information

NPI: 1649220955
Provider Name (Legal Business Name): IRENE TIEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 E CONCORD ST RM 6215
BOSTON MA
02118-2644
US

IV. Provider business mailing address

2 CLARENDON ST APT 702
BOSTON MA
02116-6137
US

V. Phone/Fax

Practice location:
  • Phone: 617-414-4397
  • Fax: 617-414-4393
Mailing address:
  • Phone: 617-267-1217
  • Fax: 617-267-1217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number159223
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License Number159223
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: