MEDICARE: EVA LI D.O.

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	207V00000X	Obstetrics & Gynecology Physician	0116027458	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0102205295	OTHER	VA	MEDICAL LICENSE

General Provider Information

NPI Number	:	1487066437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVA LI D.O.

Provider Business Mailing Address
First Line	:	PO BOX 37174
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21297-3174
Country	:	US
Telephone Number	:	571-423-5699
Fax Number	:	571-423-5698

Provider Business Practice Location Address
First Line	:	6845 ELM ST STE 600
Second Line	:
City	:	MC LEAN
State	:	VA
Zip	:	22101-6027
Country	:	US
Telephone Number	:	703-748-9880
Fax Number	:	703-748-7123

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

Provider Enumeration Date	:	05/27/2014
Last Update Date	:	11/27/2023

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Directions to “ EVA LI D.O.” Practice Location

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