MEDICARE: DR. MAOSONG QI M.D., PHD

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	207RR0500X	Rheumatology Physician	16560	NH
2	207RR0500X	Rheumatology Physician	258017	MA

General Provider Information

NPI Number	:	1831333608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAOSONG QI M.D., PHD

Provider Business Mailing Address
First Line	:	354 MERRIMACK ST STE 1
Second Line	:
City	:	LAWRENCE
State	:	MA
Zip	:	01843-1755
Country	:	US
Telephone Number	:	978-687-2321
Fax Number	:	978-722-7287

Provider Business Practice Location Address
First Line	:	354 MERRIMACK ST STE 1
Second Line	:
City	:	LAWRENCE
State	:	MA
Zip	:	01843-1755
Country	:	US
Telephone Number	:	978-687-2321
Fax Number	:	978-722-7287

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

Provider Enumeration Date	:	04/24/2009
Last Update Date	:	03/04/2020

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