MEDICARE: DR. QIAN YUAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	209229	MA
2	2080P0206X	Pediatric Gastroenterology Physician	209229	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	468584	OTHER	MA	TUFTS HEALTH PLAN
2	J26557	OTHER	MA	BCBS MA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356331920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. QIAN YUAN MD

Provider Business Mailing Address
First Line	:	2000 WASHINGTON STREET
Second Line	:	SUITE 466
City	:	NEWTON LOWER FALLS
State	:	MA
Zip	:	02462
Country	:	US
Telephone Number	:	617-969-8989
Fax Number	:	617-928-0178

Provider Business Practice Location Address
First Line	:	2000 WASHINGTON STREET
Second Line	:	SUITE 466
City	:	NEWTON LOWER FALLS
State	:	MA
Zip	:	02462
Country	:	US
Telephone Number	:	617-969-8989
Fax Number	:	617-928-0178

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2005
Last Update Date	:	04/24/2012

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