Provider Demographics
NPI:1427048206
Name:ZHAO, PEI-SHAN (MD PHD)
Entity type:Individual
Prefix:
First Name:PEI-SHAN
Middle Name:
Last Name:ZHAO
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 GREENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM HEIGHTS
Mailing Address - State:MA
Mailing Address - Zip Code:02494-2026
Mailing Address - Country:US
Mailing Address - Phone:617-789-2007
Mailing Address - Fax:
Practice Address - Street 1:736 CAMBRIDGE ST
Practice Address - Street 2:ST ELIZABETHS MEDICAL CENTER
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-2907
Practice Address - Country:US
Practice Address - Phone:617-789-2007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA214053207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0199281Medicaid
MA0199281Medicaid
MA0199281Medicaid