Provider Demographics
NPI:1881776425
Name:LI, CARLOS M (MD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:M
Last Name:LI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:14 LYMAN RD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-4116
Mailing Address - Country:US
Mailing Address - Phone:716-862-6075
Mailing Address - Fax:
Practice Address - Street 1:BUFFALO VA HOSPITAL
Practice Address - Street 2:3495 BAILEY AVE.
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215
Practice Address - Country:US
Practice Address - Phone:716-862-6075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY223837208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)