Healthcare Provider Details

I. General information

NPI: 1912438086
Provider Name (Legal Business Name): JEFFREY H LIAW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2017
Last Update Date: 10/18/2023
Certification Date: 10/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6355 WALKER LANE, SUITE 308
ALEXANDRIA VA
22310-3247
US

IV. Provider business mailing address

224-D CORNWALL STREET, NW. SUITE 403
LEESBURG VA
20176-2704
US

V. Phone/Fax

Practice location:
  • Phone: 703-313-7700
  • Fax: 703-313-0178
Mailing address:
  • Phone: 703-737-6010
  • Fax: 703-443-8643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number0101278013
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number2022009912
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: