Healthcare Provider Details

I. General information

NPI: 1013038967
Provider Name (Legal Business Name): RAYMOND W LIU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 07/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST GRB 293
BOSTON MA
02114-2621
US

IV. Provider business mailing address

55 FRUIT ST GRB 293
BOSTON MA
02114-2621
US

V. Phone/Fax

Practice location:
  • Phone: 917-923-2079
  • Fax:
Mailing address:
  • Phone: 917-923-2079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number235191-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number242389
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: