Individual
DR. LESLIE SHU-TUNG FANG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
151 MERRIMAC ST, 3RD FL, BOSTON, MA 02114-4714
(617) 742-2054
(617) 742-3157
Mailing address
PO BOX 9142, CHARLESTOWN, MA 02129-9142
(617) 742-2054
(617) 742-3157
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
39471
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110037240/A
—
MA
01
—
706451
TUFTS HEALTH PLAN
MA
01
—
M09530
BCBS MA
MA
Enumeration date
10/27/2005
Last updated
04/22/2014
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