Active NPI
Willie O Siu, MD, DPHIL
- Psychiatry Physician
- Cambridge, MA
National Provider Identifier
1407142961
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 258978
- Practice address
- 1105 Massachusetts Ave
Suite 1G
Cambridge, MA 02138-5220 - Phone
- (617) 299-6794
- NPI assigned
- Jun 23, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 258978 | MA | Primary |
Addresses
Primary practice location
1105 Massachusetts Ave
Suite 1G
Cambridge, MA 02138-5220
Mailing address
1105 Massachusetts Ave
Suite 1G
Cambridge, MA 02138-5220
Phone (617) 299-6794
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 258978 | MA | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1308787200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1438560000000",
"number": "1407142961",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1105 MASSACHUSETTS AVE",
"address_2": "SUITE 1G",
"city": "CAMBRIDGE",
"state": "MA",
"postal_code": "021385220",
"telephone_number": "617-299-6794"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1105 MASSACHUSETTS AVE",
"address_2": "SUITE 1G",
"city": "CAMBRIDGE",
"state": "MA",
"postal_code": "021385220",
"telephone_number": "617-299-6794"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIU",
"first_name": "WILLIE",
"middle_name": "O",
"credential": "MD, DPHIL",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-06-23",
"last_updated": "2015-08-03",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "MA",
"license": "258978",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cambridge, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.