Provider Demographics
NPI:1740600659
Name:LI, XIAOSONG (MD)
Entity Type:Individual
Prefix:
First Name:XIAOSONG
Middle Name:
Last Name:LI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3001 S HANOVER ST
Mailing Address - Street 2:DEPT OF INTERNAL MEDICINE
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21225-1233
Mailing Address - Country:US
Mailing Address - Phone:410-350-3565
Mailing Address - Fax:410-354-0186
Practice Address - Street 1:3001 S HANOVER ST
Practice Address - Street 2:DEPT OF INTERNAL MEDICINE
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21225-1233
Practice Address - Country:US
Practice Address - Phone:410-350-3565
Practice Address - Fax:410-354-0186
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-17
Last Update Date:2019-06-19
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Provider Licenses
StateLicense IDTaxonomies
WAMD60743933207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine