Provider Demographics
NPI:1245244318
Name:LIU, JENNIFER Q (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:Q
Last Name:LIU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:QINGYANG
Other - Middle Name:
Other - Last Name:LIU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2500 INTERPLEX DR
Mailing Address - Street 2:
Mailing Address - City:FEASTERVILLE TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-6943
Mailing Address - Country:US
Mailing Address - Phone:267-991-7601
Mailing Address - Fax:267-991-7619
Practice Address - Street 1:2500 INTERPLEX DR
Practice Address - Street 2:
Practice Address - City:FEASTERVILLE TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-6943
Practice Address - Country:US
Practice Address - Phone:267-991-7601
Practice Address - Fax:267-991-7619
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200000087207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H14113OtherUPIN
1245244318OtherNPI
PA258959OtherPA MEDICARE
NC8912676Medicaid
PA102803680Medicaid