Healthcare Provider Details

I. General information

NPI: 1356413579
Provider Name (Legal Business Name): BENJAMIN L. LIEBERMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 W MAIN ST SUITE 204
HOPKINTON MA
01748-1684
US

IV. Provider business mailing address

9 INDUSTRIAL RD STE 5
MILFORD MA
01757-3736
US

V. Phone/Fax

Practice location:
  • Phone: 508-435-4414
  • Fax: 508-435-4434
Mailing address:
  • Phone: 508-473-1480
  • Fax: 508-473-1210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number207955
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: