Provider Demographics
NPI:1073996518
Name:LIAUKOVICH, MAKSIM (MD)
Entity type:Individual
Prefix:DR
First Name:MAKSIM
Middle Name:
Last Name:LIAUKOVICH
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 1:104 PADDOCK ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-3990
Mailing Address - Country:US
Mailing Address - Phone:315-786-7501
Mailing Address - Fax:315-779-5306
Practice Address - Street 1:830 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-4034
Practice Address - Country:US
Practice Address - Phone:315-785-4673
Practice Address - Fax:315-788-4248
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-01
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD24077207RH0003X
NY337629207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology