Healthcare Provider Details

I. General information

NPI: 1205445038
Provider Name (Legal Business Name): YI XIANG TEO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2020
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

759 CHESTNUT ST
SPRINGFIELD MA
01107-1619
US

IV. Provider business mailing address

123 SUMMER ST
WORCESTER MA
01608-1216
US

V. Phone/Fax

Practice location:
  • Phone: 413-794-0000
  • Fax:
Mailing address:
  • Phone: 508-363-6208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number1014952
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: