Healthcare Provider Details

I. General information

NPI: 1023005667
Provider Name (Legal Business Name): TING LI M.D., PH.D., F.A.C.C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 01/15/2022
Certification Date: 01/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 LAFAYETTE ST
NORWICH CT
06360-2737
US

IV. Provider business mailing address

100 PERKINS FARM DR STE 301
MYSTIC CT
06355-4041
US

V. Phone/Fax

Practice location:
  • Phone: 860-572-5400
  • Fax: 860-245-0001
Mailing address:
  • Phone: 860-572-5400
  • Fax: 860-245-0001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number041484
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: