Provider Demographics
NPI:1174502454
Name:LIAO, OLIVIA (MD)
Entity Type:Individual
Prefix:DR
First Name:OLIVIA
Middle Name:
Last Name:LIAO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 WORTHEN RD
Mailing Address - Street 2:ATTN: AMY KILPATRICK
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-4835
Mailing Address - Country:US
Mailing Address - Phone:781-862-1620
Mailing Address - Fax:781-863-9416
Practice Address - Street 1:21 WORTHEN RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-4835
Practice Address - Country:US
Practice Address - Phone:781-862-1620
Practice Address - Fax:781-863-9416
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA75542207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3173844Medicaid
MAG36555Medicare UPIN
MA3173844Medicaid