Healthcare Provider Details

I. General information

NPI: 1104420801
Provider Name (Legal Business Name): MARC E LIEBERMAN MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2020
Last Update Date: 11/24/2020
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 36TH ST STE A
VERO BEACH FL
32960-4875
US

IV. Provider business mailing address

1600 36TH ST STE A
VERO BEACH FL
32960-4875
US

V. Phone/Fax

Practice location:
  • Phone: 772-569-7800
  • Fax: 772-569-9252
Mailing address:
  • Phone: 772-569-7800
  • Fax: 772-569-9252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MARC E LIEBERMAN
Title or Position: PHYSICIAN
Credential: MD
Phone: 772-569-7800