Healthcare Provider Details

I. General information

NPI: 1841424272
Provider Name (Legal Business Name): SHIU-CHUNG AU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2009
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 APEX DR STE 103A
MARLBOROUGH MA
01752-1860
US

IV. Provider business mailing address

11 APEX DR STE 103A
MARLBOROUGH MA
01752-1860
US

V. Phone/Fax

Practice location:
  • Phone: 508-485-7779
  • Fax:
Mailing address:
  • Phone: 508-485-7779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number240818
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number000000000
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: