Healthcare Provider Details

I. General information

NPI: 1174517239
Provider Name (Legal Business Name): EDWIN JAMES LIEBERMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

Provider Other Name: E. JAMES LIEBERMAN M.D.

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5410 CONNECTICUT AVE NW #113
WASHINGTON DC
20015-2859
US

IV. Provider business mailing address

5410 CONNECTICUT AVE NW #113
WASHINGTON DC
20015-2859
US

V. Phone/Fax

Practice location:
  • Phone: 202-362-3963
  • Fax:
Mailing address:
  • Phone: 202-362-3963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number3067
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: