Healthcare Provider Details

I. General information

NPI: 1083931786
Provider Name (Legal Business Name): QING YAN LIU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2010
Last Update Date: 04/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RM 2A33 BLDG 10 10 CENTER DRIVE
BETHESDA MD
20892-0001
US

IV. Provider business mailing address

RM 2A33 BLDG 10 10 CENTER DRIVE
BETHESDA MD
20892-0001
US

V. Phone/Fax

Practice location:
  • Phone: 301-402-2457
  • Fax: 301-402-2415
Mailing address:
  • Phone: 301-402-2457
  • Fax: 301-402-2415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number0101244234
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: