Provider Demographics
NPI:1558300152
Name:MA, XIAOLI (MD)
Entity Type:Individual
Prefix:
First Name:XIAOLI
Middle Name:
Last Name:MA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:405 DARTMOUTH ROAD
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-0123
Mailing Address - Country:US
Mailing Address - Phone:215-629-8866
Mailing Address - Fax:215-629-8867
Practice Address - Street 1:121 N 9TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-2410
Practice Address - Country:US
Practice Address - Phone:215-629-8866
Practice Address - Fax:215-629-8867
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD065188L207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018971410005Medicaid
PA0018971410005Medicaid
PA058451Medicare PIN