Healthcare Provider Details

I. General information

NPI: 1447876693
Provider Name (Legal Business Name): MING LI CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2020
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 HOSPITAL DR
GLEN BURNIE MD
21061-5803
US

IV. Provider business mailing address

218 N CHARLES ST APT 2409
BALTIMORE MD
21201-4027
US

V. Phone/Fax

Practice location:
  • Phone: 410-787-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberR227360
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number127527
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: