Healthcare Provider Details

I. General information

NPI: 1154615300
Provider Name (Legal Business Name): ANNIE Y LIU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2011
Last Update Date: 06/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BROOKLINE AVE KIRSTEIN 317
BOSTON MA
02215-5400
US

IV. Provider business mailing address

330 BROOKLINE AVE KIRSTEIN 317
BOSTON MA
02215-5400
US

V. Phone/Fax

Practice location:
  • Phone: 617-667-2285
  • Fax: 617-667-4173
Mailing address:
  • Phone: 617-667-2285
  • Fax: 617-667-4173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number248491
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: