Provider Demographics
NPI:1295931038
Name:LI, WEIGUO VICTOR (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:WEIGUO
Middle Name:VICTOR
Last Name:LI
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 CLARK AVE STE 17A
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-1438
Mailing Address - Country:US
Mailing Address - Phone:610-768-7168
Mailing Address - Fax:610-768-7169
Practice Address - Street 1:625 CLARK AVE STE 17A
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-1438
Practice Address - Country:US
Practice Address - Phone:610-768-7168
Practice Address - Fax:610-768-7169
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2014-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD432040207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101963965Medicaid