Provider Demographics
NPI:1598080061
Name:LI, QIAN (DO)
Entity Type:Individual
Prefix:
First Name:QIAN
Middle Name:
Last Name:LI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1803 MOUNT ROSE AVE
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-3026
Mailing Address - Country:US
Mailing Address - Phone:717-851-1405
Mailing Address - Fax:717-812-2495
Practice Address - Street 1:1001 S GEORGE ST
Practice Address - Street 2:FLOOR 3
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-3676
Practice Address - Country:US
Practice Address - Phone:717-812-4005
Practice Address - Fax:717-812-2495
Is Sole Proprietor?:No
Enumeration Date:2010-03-28
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS016382207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1621255OtherGATEWAY
PA30153372OtherAMERIHEALTH CARITAS - THFP
PA30153666OtherAMERIHEALTH CARITAS - WMG
PA102828190001Medicaid
PA102828419Medicaid
PA2897161OtherHIGHMARK BLUE SHIELD
PA420198OtherUPMC
PA289866FLTMedicare PIN
PA102828419Medicaid