Healthcare Provider Details

I. General information

NPI: 1073001707
Provider Name (Legal Business Name): XING LI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2018
Last Update Date: 07/09/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST
BOSTON MA
02114-2621
US

IV. Provider business mailing address

218 HURLEY ST
CAMBRIDGE MA
02141-2131
US

V. Phone/Fax

Practice location:
  • Phone: 617-724-4133
  • Fax:
Mailing address:
  • Phone: 607-280-8985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number286960
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: