Individual
DR. XIAODUO FAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
365 PLANTATION ST, WORCESTER, MA 01605-2397
(508) 860-1260
(508) 334-2537
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
(800) 225-8885
(508) 334-1977
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
225438
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110077735A
—
MA
Enumeration date
11/03/2005
Last updated
11/22/2020
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