Provider Demographics
NPI:1548207392
Name:LI, JOSEPH Y (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:Y
Last Name:LI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1560
Mailing Address - Country:US
Mailing Address - Phone:740-446-5371
Mailing Address - Fax:740-446-5711
Practice Address - Street 1:90 JACKSON PIKE
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-1560
Practice Address - Country:US
Practice Address - Phone:740-446-5371
Practice Address - Fax:740-446-5711
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-06-5386208000000X
WV17614208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000181974OtherUNISON MEDICAID
KY7100103520Medicaid
001714062OtherMOUNTAIN STATE BCBS
WV0108698000Medicaid
OH0931595Medicaid
OH310917085034OtherCARESOURCE MEDICAID
WV000000006521OtherANTHEM BCBS
000000007473OtherANTHEM BCBS
OH0931595OtherMOLINA MEDICAID
370008779OtherRR MEDICARE
WV0880092Medicare PIN
370008779OtherRR MEDICARE
WV0108698000Medicaid