Healthcare Provider Details

I. General information

NPI: 1053507301
Provider Name (Legal Business Name): LIAO ACUPUNCTURE GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2007
Last Update Date: 01/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 OSLER DR ROOM 215
TOWSON MD
21204-7735
US

IV. Provider business mailing address

7600 OSLER DR ROOM 215
TOWSON MD
21204-7735
US

V. Phone/Fax

Practice location:
  • Phone: 410-825-6667
  • Fax: 410-828-1638
Mailing address:
  • Phone: 410-825-6667
  • Fax: 410-828-1638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberD0014526
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License NumberD0014526
License Number StateMD

VIII. Authorized Official

Name: ALBERT LIAO
Title or Position: MEMBER, LIAO ACUPUNCTURE GROUP, LLC
Credential: L.AC.
Phone: 410-825-6667