Provider Demographics
NPI:1437146180
Name:LI, INA (MD)
Entity Type:Individual
Prefix:DR
First Name:INA
Middle Name:
Last Name:LI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:695 MEADOWBROOK LN
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-4212
Mailing Address - Country:US
Mailing Address - Phone:484-442-8355
Mailing Address - Fax:
Practice Address - Street 1:1401 FOULK RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-2763
Practice Address - Country:US
Practice Address - Phone:302-477-4511
Practice Address - Fax:302-428-6390
Is Sole Proprietor?:No
Enumeration Date:2005-09-28
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78650207QG0300X
DEC1-0008092207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H22157Medicare UPIN
DE015233C26Medicare PIN
DE019719C19Medicare PIN