Healthcare Provider Details

I. General information

NPI: 1871798165
Provider Name (Legal Business Name): DR. GILLIAN LIEBERMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 DEACONESS RD WCC RADIOLOGY 3RD FL
BOSTON MA
02215-5321
US

IV. Provider business mailing address

211 WESTERLY RD
WESTON MA
02493-1152
US

V. Phone/Fax

Practice location:
  • Phone: 617-754-2597
  • Fax: 617-754-2545
Mailing address:
  • Phone: 617-754-3597
  • Fax: 671-754-2545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number50211
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: