Healthcare Provider Details

I. General information

NPI: 1649831710
Provider Name (Legal Business Name): LAWRENCE HSU LIN MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2019
Last Update Date: 04/26/2024
Certification Date: 04/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST
BOSTON MA
02114-2621
US

IV. Provider business mailing address

55 FRUIT ST, WRN 225
BOSTON MA
02114
US

V. Phone/Fax

Practice location:
  • Phone: 617-643-0800
  • Fax: 617-726-7474
Mailing address:
  • Phone: 617-643-0800
  • Fax: 617-726-7474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number295219
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number295219
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: