Healthcare Provider Details

I. General information

NPI: 1316055122
Provider Name (Legal Business Name): PHILIP G LIU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 03/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 PARK STREET
HONESDALE PA
18431
US

IV. Provider business mailing address

650 PARK STREET
HONESDALE PA
18431
US

V. Phone/Fax

Practice location:
  • Phone: 570-253-0202
  • Fax: 570-253-1701
Mailing address:
  • Phone: 570-253-0202
  • Fax: 570-253-1701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD -035676E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: