Basic Information
| Provider Information | |||||||||
| NPI: | 1184600017 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LI | ||||||||
| FirstName: | HONGMEI | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D.,PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1380 SOLDIERS FIELD RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | BRIGHTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021351023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6172547284 | ||||||||
| FaxNumber: | 6172544116 | ||||||||
| Practice Location | |||||||||
| Address1: | 1380 SOLDIERS FIELD RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | BRIGHTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021351023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6172547284 | ||||||||
| FaxNumber: | 6172544116 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2005 | ||||||||
| LastUpdateDate: | 03/19/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZD0900X | 209962 | MA | Y | Allopathic & Osteopathic Physicians | Pathology | Dermatopathology |
ID Information
| ID | Type | State | Issuer | Description | 0171450 | 05 | MA | MEDICAID |