Individual
DR. MAI TRUC PHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
388 COMMONWELATH AVE MBB, MGH BACK BAY, BOSTON, MA 02215-2800
(617) 267-7171
(617) 262-2608
Mailing address
PO BOX 9142, MASS GENERAL PHYSICIAN ORGANIZATION, CHARLESTOWN, MA 02129-9142
(617) 267-7171
(617) 262-2608
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
153182
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
153182
TUFTS HEALTH PLAN
MA
05
—
3167488
—
MA
01
—
J17866
BCBS MA
MA
Enumeration date
10/25/2005
Last updated
11/26/2012
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