Healthcare Provider Details

I. General information

NPI: 1831465020
Provider Name (Legal Business Name): WUQIANG FAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2012
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRANCIS ST
BOSTON MA
02115-6110
US

IV. Provider business mailing address

399 REVOLUTION DR STE 580
SOMERVILLE MA
02145-1572
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-5500
  • Fax: 610-258-3047
Mailing address:
  • Phone: 610-258-1400
  • Fax: 610-258-3047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD455239
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: