Healthcare Provider Details

I. General information

NPI: 1912497629
Provider Name (Legal Business Name): AMANDA RACHEL LIU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2018
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 SPRUCE STREET
PHILADELPHIA PA
19104-4206
US

IV. Provider business mailing address

3401 CIVIC CENTER BLVD
PHILADELPHIA PA
19104-4319
US

V. Phone/Fax

Practice location:
  • Phone: 215-662-3000
  • Fax: 215-662-7011
Mailing address:
  • Phone: 215-662-3000
  • Fax: 215-662-7011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD491022
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: