Healthcare Provider Details

I. General information

NPI: 1831021583
Provider Name (Legal Business Name): JING LI MD PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 INNOVATION DR STE 3
WORCESTER MA
01605-4306
US

IV. Provider business mailing address

1 INNOVATION DR STE 3
WORCESTER MA
01605-4306
US

V. Phone/Fax

Practice location:
  • Phone: 774-442-4925
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License NumberNA
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: