Provider Demographics
NPI:1497719132
Name:LI, XIANGYANG (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:XIANGYANG
Middle Name:
Last Name:LI
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 EAST MAIN ST. SUIT# 204
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757
Mailing Address - Country:US
Mailing Address - Phone:508-458-9060
Mailing Address - Fax:508-458-9060
Practice Address - Street 1:229 EAST MAIN ST SUIT #204
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757
Practice Address - Country:US
Practice Address - Phone:508-458-9060
Practice Address - Fax:508-458-9060
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1607302084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3205240Medicaid
MA3205240Medicaid