Provider Demographics
NPI:1023005667
Name:LI, TING (MD, PHD, FACC)
Entity Type:Individual
Prefix:DR
First Name:TING
Middle Name:
Last Name:LI
Suffix:
Gender:M
Credentials:MD, PHD, FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PERKINS FARM DR STE 301
Mailing Address - Street 2:
Mailing Address - City:MYSTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06355-4041
Mailing Address - Country:US
Mailing Address - Phone:860-572-5400
Mailing Address - Fax:860-245-0001
Practice Address - Street 1:112 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2737
Practice Address - Country:US
Practice Address - Phone:860-572-5400
Practice Address - Fax:860-245-0001
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2022-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT041484207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT060001807Medicare PIN
I05761Medicare UPIN