Provider Demographics
NPI:1104822006
Name:QIAN, LIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:LIAN
Middle Name:
Last Name:QIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1149 BOYD AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-4441
Mailing Address - Country:US
Mailing Address - Phone:814-535-5120
Mailing Address - Fax:814-534-9372
Practice Address - Street 1:1086 FRANKLIN ST
Practice Address - Street 2:RM 205B
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-4305
Practice Address - Country:US
Practice Address - Phone:814-534-9822
Practice Address - Fax:814-534-9372
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 429160207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64087745Medicaid
KY3375348Medicare ID - Type Unspecified
KYI10361Medicare UPIN