Healthcare Provider Details

I. General information

NPI: 1871108191
Provider Name (Legal Business Name): MENG LIU DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2020
Last Update Date: 02/14/2025
Certification Date: 02/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13478 CARROLLTON BLVD STE O
CARROLLTON VA
23314-3209
US

IV. Provider business mailing address

5735 RIDGE AVE
PHILADELPHIA PA
19128-1745
US

V. Phone/Fax

Practice location:
  • Phone: 757-712-3532
  • Fax: 757-866-5430
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number0103301409
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0103301409
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number0103301409
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: