1356338032 NPI number — DR. MARK K LI M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356338032 NPI number — DR. MARK K LI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LI
Provider First Name:
MARK
Provider Middle Name:
K
Provider Name Prefix Text:
DR.
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:
1356338032
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1721 UNIVERSITY BLVD W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHEATON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20902-3650
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-649-5151
Provider Business Mailing Address Fax Number:
301-649-7368

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1721 UNIVERSITY BLVD W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHEATON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20902-3650
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-649-5151
Provider Business Practice Location Address Fax Number:
301-649-7368
Provider Enumeration Date:
09/29/2005

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: 207R00000X , with the licence number:  D0027865 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 85347 . This is a "ALLIANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3493546 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 85347 . This is a "MDIPA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 04960807 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110003971 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 0075758 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4081271 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 413303 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 37220001 . This is a "CAREFIRST BCBS (NCA)" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 494439 . This is a "NCPPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 139301400 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 27865 . This is a "ADVENTIST HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4958MK . This is a "CAREFIRST BCBS (MARYLAND)" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 85347 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 85347 . This is a "OPTIMUM CHOICE" identifier . This identifiers is of the category "OTHER".




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