Provider Demographics
NPI:1629172028
Name:LI, MIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MIAN
Middle Name:
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 1:9316 COPENHAVER DR
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-3021
Mailing Address - Country:US
Mailing Address - Phone:301-545-0072
Mailing Address - Fax:
Practice Address - Street 1:50 IRVING STREET, NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON, DC
Practice Address - State:DC
Practice Address - Zip Code:20422-0002
Practice Address - Country:US
Practice Address - Phone:202-745-8249
Practice Address - Fax:202-518-4666
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 810842084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH23860Medicare UPIN
FL35962ZMedicare ID - Type Unspecified