Provider Demographics
NPI:1649388554
Name:LIU, ROSITA O (MD)
Entity Type:Individual
Prefix:
First Name:ROSITA
Middle Name:O
Last Name:LIU
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 1:650 PARK STREET
Mailing Address - Street 2:
Mailing Address - City:HONESDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18431
Mailing Address - Country:US
Mailing Address - Phone:570-253-0202
Mailing Address - Fax:570-253-1701
Practice Address - Street 1:650 PARK STREET
Practice Address - Street 2:
Practice Address - City:HONESDALE
Practice Address - State:PA
Practice Address - Zip Code:18431
Practice Address - Country:US
Practice Address - Phone:570-253-0202
Practice Address - Fax:570-253-1701
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD036318E207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01346923OtherLICENSE
PA001074680Medicaid
PA001074680Medicaid
NYA400008380Medicare PIN
NY01346923OtherLICENSE