Healthcare Provider Details

I. General information

NPI: 1811790629
Provider Name (Legal Business Name): WENTAO LIU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2025
Last Update Date: 03/28/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 ARUNDEL MILLS CIR STE 319
HANOVER MD
21076-1291
US

IV. Provider business mailing address

3336 BURTON DR
ELLICOTT CITY MD
21042-1314
US

V. Phone/Fax

Practice location:
  • Phone: 240-273-8747
  • Fax: 240-273-8747
Mailing address:
  • Phone: 240-273-8747
  • Fax: 240-273-8747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberU03073
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: