Provider Demographics
NPI:1942256235
Name:LIU, HENRY T (MD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:T
Last Name:LIU
Suffix:
Gender:M
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:PO BOX 783311
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-3311
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1251 S CEDAR CREST BLVD
Practice Address - Street 2:SUITE 102A
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6205
Practice Address - Country:US
Practice Address - Phone:610-402-3940
Practice Address - Fax:610-402-3950
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD066208L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA025443Medicare ID - Type Unspecified
PAG88996Medicare UPIN
PA279779OtherHIGHMARK BLUE SHIELD
PA0320864000OtherINDEPENDENCE BLUE CROSS
PA52167OtherGEISINGER HEALTH PLAN