Provider Demographics
NPI:1497072425
Name:LI, ANDREA HO-WAN (MD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:HO-WAN
Last Name:LI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:18 NATALIE RD
Mailing Address - Street 2:
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-4239
Mailing Address - Country:US
Mailing Address - Phone:646-818-9383
Mailing Address - Fax:
Practice Address - Street 1:27 PARK ST
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-5203
Practice Address - Country:US
Practice Address - Phone:508-862-5114
Practice Address - Fax:508-862-7316
Is Sole Proprietor?:No
Enumeration Date:2010-04-30
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA277701207P00000X
NY274802207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03891738Medicaid