Provider Demographics
NPI:1396092698
Name:LI, QIU CI (PA-C)
Entity type:Individual
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First Name:QIU CI
Middle Name:
Last Name:LI
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:200 MILL RD STE 180
Mailing Address - Street 2:
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-5255
Mailing Address - Country:US
Mailing Address - Phone:508-973-2000
Mailing Address - Fax:508-973-2001
Practice Address - Street 1:300A FAUNCE CORNER RD
Practice Address - Street 2:
Practice Address - City:NORTH DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-1280
Practice Address - Country:US
Practice Address - Phone:508-973-1140
Practice Address - Fax:508-973-1145
Is Sole Proprietor?:No
Enumeration Date:2012-08-07
Last Update Date:2020-04-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MAS80674161363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3HZN21427880Medicaid