Provider Demographics
NPI:1396734216
Name:LI, LI (MD)
Entity type:Individual
Prefix:DR
First Name:LI
Middle Name:
Last Name:LI
Suffix:
Gender:M
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:PO BOX 9007
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22906-9007
Mailing Address - Country:US
Mailing Address - Phone:434-295-1000
Mailing Address - Fax:434-972-4266
Practice Address - Street 1:1221 LEE STREET
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22908-0001
Practice Address - Country:US
Practice Address - Phone:434-924-5348
Practice Address - Fax:434-924-8335
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101265674207Q00000X
OH35078462L207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2231669Medicaid
OH363767OtherWELLCARE MEDICAID
OH2499012OtherAETNA
OH363766OtherWELLCARE
OH7545197OtherAETNA
OH000000213625OtherUNISON
OH737681OtherBUCKEYE
OH000000503553OtherANTHEM
OH000000530392OtherANTHEM
OH2231669Medicaid
OHLI4045323Medicare PIN