Healthcare Provider Details

I. General information

NPI: 1134552011
Provider Name (Legal Business Name): TIFFANY SARA LIU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2013
Last Update Date: 11/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 BOULTON ST
BEL AIR MD
21014-4255
US

IV. Provider business mailing address

9910 FRANKLIN SQUARE DR STE 2110
BALTIMORE MD
21236-4902
US

V. Phone/Fax

Practice location:
  • Phone: 410-399-8426
  • Fax: 410-399-8427
Mailing address:
  • Phone: 410-933-6423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberD83064
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: