Basic Information
Provider Information
NPI: 1457670408
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ZHANG
FirstName: SHAOXIONG
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1500 MARKET ST
Address2: 24TH FLOOR-WEST TOWER
City: PHILADELPHIA
State: PA
PostalCode: 191022100
CountryCode: US
TelephoneNumber: 2152553828
FaxNumber: 2152553577
Practice Location
Address1: 230 N BROAD ST
Address2:  
City: PHILADELPHIA
State: PA
PostalCode: 191021121
CountryCode: US
TelephoneNumber: 2157621808
FaxNumber: 2157624721
Other Information
ProviderEnumerationDate: 05/28/2010
LastUpdateDate: 06/30/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085R0202XMD452194PAY Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology

No ID Information.


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