Provider Demographics
NPI:1326225384
Name:WAYNE W Y LIU MD PA
Entity Type:Organization
Organization Name:WAYNE W Y LIU MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:W Y
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:301-423-5540
Mailing Address - Street 1:3611 BRANCH AVE
Mailing Address - Street 2:
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-1242
Mailing Address - Country:US
Mailing Address - Phone:301-423-5540
Mailing Address - Fax:301-426-8491
Practice Address - Street 1:3611 BRANCH AVE
Practice Address - Street 2:
Practice Address - City:TEMPLE HILLS
Practice Address - State:MD
Practice Address - Zip Code:20748-1242
Practice Address - Country:US
Practice Address - Phone:301-423-5540
Practice Address - Fax:301-426-8491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG01431Medicare PIN