Healthcare Provider Details

I. General information

NPI: 1609945765
Provider Name (Legal Business Name): REFENG YAO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 11/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARITAS ST. ELIZABETH 'S HOSPITAL 736 CAMBRIDGE STREET
BRIGHTON MA
01235
US

IV. Provider business mailing address

117 LAKE SHORE RD APARTMENT #3
BRIGHTON MA
02135-6316
US

V. Phone/Fax

Practice location:
  • Phone: 617-789-3000
  • Fax:
Mailing address:
  • Phone: 617-789-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number230483
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: