Healthcare Provider Details

I. General information

NPI: 1194974212
Provider Name (Legal Business Name): LI LI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2008
Last Update Date: 09/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CRC ROOM 1 1469 BLDG 10 10 CENTER DRIVE, MSC 1604
BETHESDA MD
20892-0001
US

IV. Provider business mailing address

CRC ROOM 1 1469 BLDG 10 10 CENTER DRIVE, MSC 1604
BETHESDA MD
20892-0001
US

V. Phone/Fax

Practice location:
  • Phone: 301-496-4733
  • Fax: 301-480-0669
Mailing address:
  • Phone: 301-496-4733
  • Fax: 301-480-0669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberD0056970
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2081N0008X
TaxonomyNeuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
License NumberD0056970
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: