Provider Demographics
NPI:1215974464
Name:LIAO, BAOLANG (MD)
Entity type:Individual
Prefix:DR
First Name:BAOLANG
Middle Name:
Last Name:LIAO
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 1:16220 S FREDERICK AVE
Mailing Address - Street 2:SUITE 418
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-4039
Mailing Address - Country:US
Mailing Address - Phone:301-926-9088
Mailing Address - Fax:301-926-3999
Practice Address - Street 1:16220 S FREDERICK AVE
Practice Address - Street 2:SUITE 418
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-4039
Practice Address - Country:US
Practice Address - Phone:301-926-9088
Practice Address - Fax:301-926-3999
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0056595207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
490855Medicare ID - Type Unspecified
H11322Medicare UPIN