Provider Demographics
NPI:1225067804
Name:LIAO, LYDIA (MD, PHD, MPH)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:
Last Name:LIAO
Suffix:
Gender:F
Credentials:MD, PHD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 CHAPEL AVE W
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-2048
Mailing Address - Country:US
Mailing Address - Phone:856-488-6500
Mailing Address - Fax:856-488-6507
Practice Address - Street 1:2201 CHAPEL AVE W
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-2048
Practice Address - Country:US
Practice Address - Phone:856-488-6500
Practice Address - Fax:856-488-6507
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2302132085R0202X
NJ25MA080706002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2360963OtherUNITED HEALTHCARE
NJ2779286000OtherAMERIHEALTH/KEYSTONE/IBC
NY02496871Medicaid
NJ60026657OtherHORIZON NJ HEALTH
NJ3818841OtherCIGNA
NJ1352535OtherAETNA
NJP3737619OtherOXFORD
NJ01077798200OtherAMERICHOICE
NJ0119636Medicaid
NJ60026657OtherHORIZON NJ HEALTH
NJ2360963OtherUNITED HEALTHCARE
NJP3737619OtherOXFORD