Healthcare Provider Details

I. General information

NPI: 1750565891
Provider Name (Legal Business Name): DAVID MARCUS LIEBERMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2007
Last Update Date: 07/16/2020
Certification Date: 07/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 ADDISON AVE
PALO ALTO CA
94301-2401
US

IV. Provider business mailing address

105 ADDISON AVE
PALO ALTO CA
94301-2401
US

V. Phone/Fax

Practice location:
  • Phone: 650-327-3232
  • Fax: 650-327-1973
Mailing address:
  • Phone: 650-327-3232
  • Fax: 650-327-1973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberA101911
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: