Provider Demographics
NPI:1306809033
Name:LIAO, PETER S (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:S
Last Name:LIAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:8860 COLUMBIA 100 PKWY STE 400
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-2384
Mailing Address - Country:US
Mailing Address - Phone:410-964-8346
Mailing Address - Fax:410-964-8350
Practice Address - Street 1:8860 COLUMBIA 100 PKWY STE 400
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2384
Practice Address - Country:US
Practice Address - Phone:410-964-8346
Practice Address - Fax:410-964-8350
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0057934208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS123-0050OtherCAREFIRST REGIONAL
MDKJ22/631012-02OtherCAREFIRST MARYLAND
MD699431800Medicaid
MDS123-0050OtherCAREFIRST REGIONAL
H25555Medicare UPIN