Provider Demographics
NPI:1649237058
Name:LIU, PAUL Y (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:Y
Last Name:LIU
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 1:50 MAUDE ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908-4325
Mailing Address - Country:US
Mailing Address - Phone:401-456-5368
Mailing Address - Fax:401-456-5782
Practice Address - Street 1:50 MAUDE ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-4325
Practice Address - Country:US
Practice Address - Phone:401-456-2441
Practice Address - Fax:401-456-6745
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI109282086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7021553Medicaid
RI007057483Medicare ID - Type Unspecified
RI7021553Medicaid