Basic Information
Provider Information
NPI: 1942681366
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LAU-MIN
FirstName: KELSEY
MiddleName: S
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 6 FRANCES RD
Address2:  
City: LEXINGTON
State: MA
PostalCode: 024217512
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: MASSACHUSETTS GENERAL HOSPITAL
Address2: 55 FRUIT ST.
City: BOSTON
State: MA
PostalCode: 02114
CountryCode: US
TelephoneNumber: 6177246620
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/11/2015
LastUpdateDate: 06/15/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/15/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XL-263124MAN Allopathic & Osteopathic PhysiciansInternal Medicine 
207RX0202XMD473701PAN Allopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
207RX0202X273311MAY Allopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology

No ID Information.


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