Healthcare Provider Details

I. General information

NPI: 1841394392
Provider Name (Legal Business Name): RICHARD LIU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 06/02/2021
Certification Date: 06/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 GEORGIA AVE NW WALTER REED AMC
WASHINGTON DC
20307-0003
US

IV. Provider business mailing address

2445 LYTTONSVILLE RD APT 707
SILVER SPRING MD
20910-1933
US

V. Phone/Fax

Practice location:
  • Phone: 202-782-0039
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number21553
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: