Individual provider Active NPI

Chien-Wei Eric Liao, MD, PHD

  • Plastic and Reconstructive Surgery Physician
  • Philadelphia, PA
National Provider Identifier
1073706438
Registry record updated Feb 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X
License
MD478104 Issued in PA
Practice address
3401 Civic Center Blvd
Philadelphia, PA 19104-4319
Phone
(215) 590-2208
NPI assigned
Aug 20, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic and Reconstructive Surgery Physician 2086S0122X L-214510 MA
Plastic and Reconstructive Surgery Physician 2086S0122X MD478104 PA Primary

Addresses

Primary practice location

3401 Civic Center Blvd
Philadelphia, PA 19104-4319

Mailing address

55 Fruit St
Massachusetts General Hospital
Boston, MA 02114-2621
Phone (617) 726-2066

Other practice location 1

51 Blossom St
Boston, MA 02114-2601
Phone (617) 722-3000

Other practice location 2

55 Fruit St
Massachusetts General Hospital
Boston, MA 02114-2621
Phone (617) 726-2066

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230509001999 PA Practitioner - Plastic and Reconstructive Surgery 1052482254 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine, Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
L-214510MAMDPlastic and Reconstructive Surgery Physician
MD478104PAMDPlastic and Reconstructive Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Children'S Surgical Associates LTD CurrentSince Jan 27, 2023 Accepting new patients
Children'S Surgical Associates LTD Current Accepting new patients
Children'S Surgical Associates LTD CurrentSince Jan 27, 2023 Accepting new patients
Children'S Surgical Associates LTD Past Accepting new patients

Locations

3401 Civic Center Blvd
Philadelphia, PA 19104
Phone (215) 590-4040

3500 Civic Center Blvd
Philadelphia, PA 19104
Phone (215) 590-2169

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1187568000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675987200000",
    "number": "1073706438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 FRUIT ST",
            "address_2": "MASSACHUSETTS GENERAL HOSPITAL",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021142621",
            "telephone_number": "617-726-2066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 CIVIC CENTER BLVD",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044319",
            "telephone_number": "215-590-2208"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "51 Blossom St",
            "address_purpose": "LOCATION",
            "city": "Boston",
            "state": "MA",
            "postal_code": "021142601",
            "country_code": "US",
            "telephone_number": "617-722-3000",
            "fax_number": "617-367-8936",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "55 Fruit St",
            "address_2": "Massachusetts General Hospital",
            "address_purpose": "LOCATION",
            "city": "Boston",
            "state": "MA",
            "postal_code": "021142621",
            "country_code": "US",
            "telephone_number": "617-726-2066",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LIAO",
        "first_name": "CHIEN-WEI",
        "middle_name": "ERIC",
        "credential": "MD, PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-08-20",
        "last_updated": "2023-02-10",
        "certification_date": "2023-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "MA",
            "license": "L-214510",
            "primary": false
        },
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "PA",
            "license": "MD478104",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.