Healthcare Provider Details

I. General information

NPI: 1548215643
Provider Name (Legal Business Name): MING Y. LIU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 01/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2204 WILBORN AVE
SOUTH BOSTON VA
24592-1645
US

IV. Provider business mailing address

2232 WILBORN AVE
SOUTH BOSTON VA
24592-1662
US

V. Phone/Fax

Practice location:
  • Phone: 434-517-3100
  • Fax: 434-517-3602
Mailing address:
  • Phone: 434-517-3539
  • Fax: 434-517-3602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number0101234023
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: