Healthcare Provider Details

I. General information

NPI: 1962195800
Provider Name (Legal Business Name): YILING LIU DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: IRENE LIU DO

II. Dates (important events)

Enumeration Date: 05/26/2023
Last Update Date: 05/26/2023
Certification Date: 05/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 S RAILROAD ST
TAMAQUA PA
18252-1927
US

IV. Provider business mailing address

34 S RAILROAD ST
TAMAQUA PA
18252-1927
US

V. Phone/Fax

Practice location:
  • Phone: 570-645-1950
  • Fax: 570-645-1955
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOT022337
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: