1699766147 NPI number — JAMES LI M.D.

Table of content: JAMES LI M.D. (NPI 1699766147)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699766147 NPI number — JAMES LI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LI
Provider First Name:
JAMES
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699766147
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/02/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 24
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRIENDSHIP
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04547-0024
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-691-4366
Provider Business Mailing Address Fax Number:
815-550-2395

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
35 MILES ST
Provider Second Line Business Practice Location Address:
MILES MEDICAL GROUP
Provider Business Practice Location Address City Name:
DAMARISCOTTA
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04543-4047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-563-4521
Provider Business Practice Location Address Fax Number:
207-563-3717
Provider Enumeration Date:
11/03/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207PE0004X , with the licence number:  016090 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 408440099 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3169227 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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