Provider Demographics
NPI:1356338032
Name:LI, MARK K (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:K
Last Name:LI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1721 UNIVERSITY BLVD W
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:MD
Mailing Address - Zip Code:20902-3650
Mailing Address - Country:US
Mailing Address - Phone:301-649-5151
Mailing Address - Fax:301-649-7368
Practice Address - Street 1:1721 UNIVERSITY BLVD W
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:MD
Practice Address - Zip Code:20902-3650
Practice Address - Country:US
Practice Address - Phone:301-649-5151
Practice Address - Fax:301-649-7368
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-29
Last Update Date:2008-04-15
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Provider Licenses
StateLicense IDTaxonomies
MDD0027865207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
85347OtherALLIANCE
3493546OtherCIGNA
85347OtherMDIPA
DC04960807Medicaid
DC110003971OtherRAILROAD MEDICARE
0075758OtherAETNA HMO
4081271OtherAETNA PPO
413303OtherUNITED HEALTHCARE
DC37220001OtherCAREFIRST BCBS (NCA)
494439OtherNCPPO
MD139301400Medicaid
27865OtherADVENTIST HEALTHCARE
MD4958MKOtherCAREFIRST BCBS (MARYLAND)
85347OtherMAMSI
85347OtherOPTIMUM CHOICE
MD4958MKOtherCAREFIRST BCBS (MARYLAND)
DC37220001OtherCAREFIRST BCBS (NCA)