Healthcare Provider Details

I. General information

NPI: 1205859816
Provider Name (Legal Business Name): JONGMING LI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 01/07/2022
Certification Date: 07/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1915 WHITE AVE
KNOXVILLE TN
37916-2300
US

IV. Provider business mailing address

2500 W 12TH ST
ERIE PA
16505-4500
US

V. Phone/Fax

Practice location:
  • Phone: 865-331-1720
  • Fax: 865-331-2823
Mailing address:
  • Phone: 814-838-9000
  • Fax: 814-838-0462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD426705
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberMD426705
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: