Healthcare Provider Details

I. General information

NPI: 1902122880
Provider Name (Legal Business Name): ERIC YEN TING LIU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2010
Last Update Date: 01/25/2022
Certification Date: 09/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4437 STATE ROUTE 159
CHILLICOTHEE OH
45601-7065
US

IV. Provider business mailing address

4437 STATE ROUTE 159
CHILLICOTHEE OH
45601-7065
US

V. Phone/Fax

Practice location:
  • Phone: 740-779-4598
  • Fax:
Mailing address:
  • Phone: 626-322-7213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number46922
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number35.131722
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number46922
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: