Provider Demographics
NPI:1104815059
Name:LIANG, WEN CHI (DO)
Entity type:Individual
Prefix:DR
First Name:WEN
Middle Name:CHI
Last Name:LIANG
Suffix:
Gender:F
Credentials:DO
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 12622
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4017
Mailing Address - Country:US
Mailing Address - Phone:443-481-6573
Mailing Address - Fax:443-481-6515
Practice Address - Street 1:2000 MEDICAL PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3742
Practice Address - Country:US
Practice Address - Phone:443-481-5300
Practice Address - Fax:443-481-6705
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34006614208600000X
MDH65424208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
58860016OtherBCBS DC
955613-03OtherBCBS MARYLAND
MD95561304OtherBCBS
DCV8080006OtherBCBS
6067644OtherAETNA HMO
OH2713184OtherGROUP MCD #
7719360OtherAETNA PPO
95561301OtherBCBS MD
DCV8380006OtherBCBS
DCV8740005OtherBCBS
OH9365601OtherGROUP MCR #
MD95561302OtherBCBS
OH2043541Medicaid
MD417471200Medicaid
MD95561302OtherBCBS
171558ZFSRMedicare PIN
160365ZEFUMedicare PIN
95561301OtherBCBS MD
P00770522Medicare PIN
160365ZFQCMedicare PIN
6067644OtherAETNA HMO
OH2043541Medicaid
OH4046712Medicare PIN
MDP00876083Medicare PIN