Basic Information
| Provider Information | |||||||||
| NPI: | 1245282508 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GUO | ||||||||
| FirstName: | XIANG-YANG | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 90 TER HEUN DR | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | FALMOUTH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 025402533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5084957160 | ||||||||
| FaxNumber: | 5084957152 | ||||||||
| Practice Location | |||||||||
| Address1: | 90 TER HEUN DR | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | FALMOUTH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 025402533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5084957160 | ||||||||
| FaxNumber: | 5084957152 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2006 | ||||||||
| LastUpdateDate: | 01/08/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 219396 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | J28862 | 01 | MA | BCBS | OTHER | 2106132 | 05 | MA | MEDICAID | SX3487 | 01 | MA | MEDICARE PTAN | OTHER | AA37710 | 01 | MA | HPHC | OTHER |