Provider Demographics
NPI:1225050404
Name:LIU, DAVID D (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:D
Last Name:LIU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:175 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:13365-1300
Mailing Address - Country:US
Mailing Address - Phone:315-823-0351
Mailing Address - Fax:315-823-1889
Practice Address - Street 1:51 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MOHAWK
Practice Address - State:NY
Practice Address - Zip Code:13407-1140
Practice Address - Country:US
Practice Address - Phone:315-866-0763
Practice Address - Fax:315-866-3414
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY218512207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02304850Medicaid
NYRA4739Medicare ID - Type Unspecified
NY02304850Medicaid