Healthcare Provider Details

I. General information

NPI: 1023017654
Provider Name (Legal Business Name): DR. GARY A. LIEBERMAN, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10313 GEORGIA AVE STE 105
SILVER SPRING MD
20902-5006
US

IV. Provider business mailing address

10313 GEORGIA AVE STE 105
SILVER SPRING MD
20902-5006
US

V. Phone/Fax

Practice location:
  • Phone: 301-681-8400
  • Fax: 301-681-3339
Mailing address:
  • Phone: 301-681-8400
  • Fax: 301-681-3339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number00532
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number00532
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number00532
License Number StateMD

VIII. Authorized Official

Name: DR. HOLLY M. BECK
Title or Position: PODIATRIST
Credential: D.P.M.
Phone: 301-681-8400