MEDICARE: VINCENT LIU IDC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1710I1002X	Independent Duty Corpsman
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1356062483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VINCENT LIU IDC

Provider Business Mailing Address
First Line	:	8901 ROCKVILLE PIKE
Second Line	:
City	:	BETHESDA
State	:	MD
Zip	:	20889-5600
Country	:	US
Telephone Number	:	301-295-4000
Fax Number	:

Provider Business Practice Location Address
First Line	:	8901 ROCKVILLE PIKE
Second Line	:
City	:	BETHESDA
State	:	MD
Zip	:	20889-5600
Country	:	US
Telephone Number	:	301-295-4000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2022
Last Update Date	:	03/19/2026

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