Healthcare Provider Details

I. General information

NPI: 1720250228
Provider Name (Legal Business Name): LEO LEE TSAI M.D., PH.D., M.SC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2008
Last Update Date: 07/20/2023
Certification Date: 07/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BROOKLINE AVE # ANSIN230
BOSTON MA
02215-5400
US

IV. Provider business mailing address

1 DEACONESS RD BIDMC DEPT OF RADIOLOGY CCW-3RD FLOOR
BOSTON MA
02215-5321
US

V. Phone/Fax

Practice location:
  • Phone: 617-667-0278
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Internal Medicine Physician
License Number236117
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number236117
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number236117
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number236117
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: