Provider Demographics
NPI:1053668145
Name:LE, THI SOM MAI (MD)
Entity type:Individual
Prefix:
First Name:THI SOM MAI
Middle Name:
Last Name:LE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 COMMONWEALTH AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-2503
Mailing Address - Country:US
Mailing Address - Phone:857-277-3125
Mailing Address - Fax:
Practice Address - Street 1:228 COMMONWEALTH AVE APT 6
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-2503
Practice Address - Country:US
Practice Address - Phone:857-277-3125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA251208390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program