Provider Demographics
NPI:1699795609
Name:THU, LE (MD)
Entity type:Individual
Prefix:DR
First Name:LE
Middle Name:
Last Name:THU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:150 STANIFORD ST
Mailing Address - Street 2:SUITE 614
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2511
Mailing Address - Country:US
Mailing Address - Phone:617-723-9883
Mailing Address - Fax:617-723-9852
Practice Address - Street 1:150 STANIFORD ST
Practice Address - Street 2:SUITE 614
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2511
Practice Address - Country:US
Practice Address - Phone:617-723-9883
Practice Address - Fax:617-723-9852
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
METD05087207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000517085OtherANTHEM
OH2760221Medicaid
MAB76489Medicare UPIN
OH2760221Medicaid
OHP00405635Medicare PIN