Healthcare Provider Details

I. General information

NPI: 1114916533
Provider Name (Legal Business Name): BRYAN - LIEBERMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 WASHINGTON ST SUITE 115
NORWOOD MA
02062-3441
US

IV. Provider business mailing address

145 GAY ST
WESTWOOD MA
02090-2596
US

V. Phone/Fax

Practice location:
  • Phone: 781-769-0465
  • Fax: 781-769-4696
Mailing address:
  • Phone: 781-329-5642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number38491
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: