Provider Demographics
NPI:1720512338
Name:LIU, BAOQIONG
Entity type:Individual
Prefix:
First Name:BAOQIONG
Middle Name:
Last Name:LIU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N EDINBURGH DR STE 102
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-4125
Mailing Address - Country:US
Mailing Address - Phone:407-845-8366
Mailing Address - Fax:
Practice Address - Street 1:100 N EDINBURGH DR STE 102
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-4125
Practice Address - Country:US
Practice Address - Phone:407-845-8366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-20
Last Update Date:2025-06-04
Deactivation Date:2017-11-27
Deactivation Code:
Reactivation Date:2018-01-10
Provider Licenses
StateLicense IDTaxonomies
IAMD-47107207R00000X
NJ25MA11391500207RC0000X
FLME171085207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine