Provider Demographics
NPI:1205859816
Name:LI, JONGMING (MD)
Entity Type:Individual
Prefix:DR
First Name:JONGMING
Middle Name:
Last Name:LI
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 1:2500 W 12TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-4500
Mailing Address - Country:US
Mailing Address - Phone:814-838-9000
Mailing Address - Fax:814-838-0462
Practice Address - Street 1:1915 WHITE AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-2300
Practice Address - Country:US
Practice Address - Phone:865-331-1720
Practice Address - Fax:865-331-2823
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD426705207R00000X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ050152Medicaid
NJ0082171Medicaid
PA101415648Medicaid
NJ0082171Medicaid