Basic Information
Provider Information | |||||||||
NPI: | 1407815483 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | YEH | ||||||||
FirstName: | DOREEN | ||||||||
MiddleName: | DEFARIA | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | DEFARIA | ||||||||
OtherFirstName: | DOREEN | ||||||||
OtherMiddleName: | ELIZABETH | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MD | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 9142 | ||||||||
Address2: | MASS GENERAL PHYSICIAN ORGANIZATION | ||||||||
City: | CHARLESTOWN | ||||||||
State: | MA | ||||||||
PostalCode: | 021299142 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6177240287 | ||||||||
FaxNumber: | 6177262894 | ||||||||
Practice Location | |||||||||
Address1: | 55 FRUIT ST | ||||||||
Address2: | CARDIOLOGY DIVISION, YAWKEY | ||||||||
City: | BOSTON | ||||||||
State: | MA | ||||||||
PostalCode: | 021142621 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6177244600 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/20/2006 | ||||||||
LastUpdateDate: | 02/24/2010 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 225610 | MA | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.