Healthcare Provider Details

I. General information

NPI: 1821022575
Provider Name (Legal Business Name): INGRID A LI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 12/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 WASHINGTON ST #1007
BOSTON MA
02111-1552
US

IV. Provider business mailing address

800 WASHINGTON ST #1007
BOSTON MA
02111-1552
US

V. Phone/Fax

Practice location:
  • Phone: 617-636-1752
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number227934
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number227934
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: