Basic Information
| Provider Information | |||||||||
| NPI: | 1275850331 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LIU | ||||||||
| FirstName: | LI | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 301 ST. PAUL PLACE | ||||||||
| Address2: | MEDICAL STAFF OFFICE | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106592802 | ||||||||
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| Practice Location | |||||||||
| Address1: | 345 ST. PAUL PLACE | ||||||||
| Address2: | PATHOLOGY DEPT., 7TH FLOOR | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103329447 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2010 | ||||||||
| LastUpdateDate: | 10/27/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | D0081369 | MD | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 0014 | 01 | MD | CAREFIRST - BLUE CHOICE | OTHER | 516464YV6 | 01 | MD | MEDICARE | OTHER |