Healthcare Provider Details

I. General information

NPI: 1043983935
Provider Name (Legal Business Name): RAN LIU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2021
Last Update Date: 07/27/2021
Certification Date: 07/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BROOKLINE AVENUE KS-B23 (PULMONARY OFFICE)
BOSTON MA
02215
US

IV. Provider business mailing address

1282 BOYLSTON ST UNIT 1926
BOSTON MA
02215-4468
US

V. Phone/Fax

Practice location:
  • Phone: 617-667-4195
  • Fax: 617-667-4849
Mailing address:
  • Phone: 617-470-6139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number287308
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: