Healthcare Provider Details

I. General information

NPI: 1578821237
Provider Name (Legal Business Name): HONGCHAO ZHOU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2012
Last Update Date: 07/30/2021
Certification Date: 07/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 CITY HALL MALL
MEDFORD MA
02155-4754
US

IV. Provider business mailing address

26 CITY HALL MALL
MEDFORD MA
02155-4754
US

V. Phone/Fax

Practice location:
  • Phone: 781-306-5437
  • Fax: 781-306-5234
Mailing address:
  • Phone: 781-306-5437
  • Fax: 781-306-5234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number254064
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number254064
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: