Individual
GARY FANJIANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
55 FRUIT ST, VBK 107, BOSTON, MA 02114-2621
(617) 724-2561
Mailing address
PO BOX 9142, CHARLESTOWN, MA 02129-9142
(617) 724-0287
(617) 726-2894
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
220677
MA
2080P0206X
Pediatric Gastroenterology Physician
220677
MA
2080P0206X
Pediatric Gastroenterology Physician
Primary
C10008372
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0152188
—
NJ
05
—
102104221
—
PA
05
—
4141563
—
MD
Enumeration date
10/27/2005
Last updated
09/03/2008
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