Provider Demographics
NPI:1700414042
Name:LIAO, CHARLENE ASHLEY (MD)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:ASHLEY
Last Name:LIAO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1152 KINGS HIGHWAY CUTOFF
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-5271
Mailing Address - Country:US
Mailing Address - Phone:203-256-5500
Mailing Address - Fax:203-255-0046
Practice Address - Street 1:1152 KINGS HIGHWAY CUTOFF
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-5271
Practice Address - Country:US
Practice Address - Phone:203-256-5500
Practice Address - Fax:203-255-0046
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT75746207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine