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General NPI Number Information
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NPI Number | 1649620360
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Entity Type | Individual
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Provider Name | DUY QUOC LY M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/14/2016
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Last Update Date | 02/05/2020
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Provider Practice Location Address
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Address Line | 940 BELMONT ST PSYCHIATRY 116A7
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City | BROCKTON
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State | MA
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Zip | 02301-5596
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Country | US
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Telephone | 774-826-2456
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Fax |
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Provider Business Mailing Address
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Address Line | 562 AUSTIN LN
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City | LEWISVILLE
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State | TX
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Zip | 75067-5206
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Country | US
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Telephone | 214-815-7366
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 281590
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License Number State | MA
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