Provider Demographics
NPI: | 1629392493 |
---|---|
Name: | LIAO, NANCY NAI-HSIEN (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | NANCY |
Middle Name: | NAI-HSIEN |
Last Name: | LIAO |
Suffix: | |
Gender: | F |
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: | 700 CHILDREN'S DRIVE |
Mailing Address - Street 2: | |
Mailing Address - City: | COLUMBUS |
Mailing Address - State: | OH |
Mailing Address - Zip Code: | 43205-2664 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 614-722-4950 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 700 CHILDREN'S DRIVE |
Practice Address - Street 2: | |
Practice Address - City: | COLUMBUS |
Practice Address - State: | OH |
Practice Address - Zip Code: | 43205-2664 |
Practice Address - Country: | US |
Practice Address - Phone: | 614-722-4950 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2010-03-22 |
Last Update Date: | 2020-03-09 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
OH | 35098576 | 2080P0008X, 208M00000X |
OH | 35.098576 | 208000000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist | |
No | 2080P0008X | Allopathic & Osteopathic Physicians | Pediatrics | Neurodevelopmental Disabilities |
No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
OH | 0078706 | Medicaid |