Healthcare Provider Details

I. General information

NPI: 1508515131
Provider Name (Legal Business Name): TED CHO MD, MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2022
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVENUE, BCH3066
BOSTON MA
02115
US

IV. Provider business mailing address

50 LONGWOOD AVE APT 811
BROOKLINE MA
02446-5291
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-6624
  • Fax: 617-730-0335
Mailing address:
  • Phone: 317-938-8461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1022971
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: