Provider Demographics
NPI:1467443150
Name:TSO, LI (MD)
Entity type:Individual
Prefix:DR
First Name:LI
Middle Name:
Last Name:TSO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 HASTINGS ST
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-5439
Mailing Address - Country:US
Mailing Address - Phone:781-772-8100
Mailing Address - Fax:781-772-8101
Practice Address - Street 1:70 HASTINGS ST
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-5439
Practice Address - Country:US
Practice Address - Phone:781-772-8100
Practice Address - Fax:781-772-8101
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA75440207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ12245OtherBCBS MA
MA3091058Medicaid
MA727225OtherTUFTS HEALTH PLAN
MA727225OtherTUFTS HEALTH PLAN
F23955Medicare UPIN