Provider Demographics
NPI:1790762599
Name:LIU, NINGCHEN (MD)
Entity Type:Individual
Prefix:DR
First Name:NINGCHEN
Middle Name:
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 1:293 CHAMBERS ST.
Mailing Address - Street 2:P.O. BOX 8
Mailing Address - City:CRESTLINE
Mailing Address - State:OH
Mailing Address - Zip Code:44827-0008
Mailing Address - Country:US
Mailing Address - Phone:419-683-3131
Mailing Address - Fax:419-683-5016
Practice Address - Street 1:293 CHAMBERS ST
Practice Address - Street 2:
Practice Address - City:CRESTLINE
Practice Address - State:OH
Practice Address - Zip Code:44827-1028
Practice Address - Country:US
Practice Address - Phone:419-683-3131
Practice Address - Fax:419-683-5016
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35 . 045747207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0453398Medicaid
OHLI 0492401Medicare ID - Type Unspecified
OHC 02037Medicare UPIN