Provider Demographics
NPI:1922125756
Name:LI, NING (MD)
Entity Type:Individual
Prefix:
First Name:NING
Middle Name:
Last Name:LI
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 1:51 COUNTRY LN
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:CT
Mailing Address - Zip Code:06524-3385
Mailing Address - Country:US
Mailing Address - Phone:203-393-1862
Mailing Address - Fax:
Practice Address - Street 1:200 WATSON BLVD
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06615-7127
Practice Address - Country:US
Practice Address - Phone:203-380-4584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT043250207ZD0900X
WAMD00043251207ZD0900X
VA0101240940207ZD0900X
NJ25MA08212800207ZD0900X
PAMD430861207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology