Healthcare Provider Details

I. General information

NPI: 1912994567
Provider Name (Legal Business Name): LI LIANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 11/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 VILLAGE SQ
CHELMSFORD MA
01824-2712
US

IV. Provider business mailing address

9 VILLAGE SQ
CHELMSFORD MA
01824-2712
US

V. Phone/Fax

Practice location:
  • Phone: 978-256-4531
  • Fax: 978-256-1377
Mailing address:
  • Phone: 978-256-4531
  • Fax: 978-256-1377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number214164
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number11815
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: