Healthcare Provider Details

I. General information

NPI: 1043134778
Provider Name (Legal Business Name): SIRUI LIU
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 BALTIMORE ANNAPOLIS BLVD STE 206
SEVERNA PARK MD
21146-3914
US

IV. Provider business mailing address

426 HILLVIEW DR APT 302
LINTHICUM HEIGHTS MD
21090-3811
US

V. Phone/Fax

Practice location:
  • Phone: 410-553-4450
  • Fax:
Mailing address:
  • Phone: 206-681-8555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLGP18287
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: