Healthcare Provider Details

I. General information

NPI: 1063049997
Provider Name (Legal Business Name): MISCHA LI COVINGTON MD, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LONGYIN LI

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRANCIS ST
BOSTON MA
02115-6110
US

IV. Provider business mailing address

31 1/2 ENGLEWOOD AVE APT 4
BROOKLINE MA
02445-2023
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-5500
  • Fax:
Mailing address:
  • Phone: 857-218-9199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number294359
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code207ZC0006X
TaxonomyClinical Pathology Physician
License Number294359
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: