Healthcare Provider Details

I. General information

NPI: 1164408746
Provider Name (Legal Business Name): DAVID ALLEN LIEB D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 01/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 HILLCREST DR SUITE 25
FREDERICK MD
21703-6107
US

IV. Provider business mailing address

10 HILLCREST DR SUITE 25
FREDERICK MD
21703-6107
US

V. Phone/Fax

Practice location:
  • Phone: 301-695-1010
  • Fax: 301-695-1010
Mailing address:
  • Phone: 301-695-1010
  • Fax: 301-695-1010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number01104
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: