Individual
LARISSA TIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
41 MALL RD, BURLINGTON, MA 01805-3300
(781) 744-8000
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
(800) 225-8885
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0110006747
VA
363A00000X
Physician Assistant
5526
GA
363A00000X
Physician Assistant
Primary
PA8833
MA
Other
Enumeration date
02/09/2009
Last updated
11/02/2022
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