Healthcare Provider Details

I. General information

NPI: 1841370988
Provider Name (Legal Business Name): RICHARD M LIEBERMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 03/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5018 MEDICAL CENTER CIRCLE SUITE 240
ALLENTOWN PA
18106-9661
US

IV. Provider business mailing address

5018 MEDICAL CENTER CIRCLE SUITE 240
ALLENTOWN PA
18106-9661
US

V. Phone/Fax

Practice location:
  • Phone: 484-876-5649
  • Fax: 610-841-3914
Mailing address:
  • Phone: 484-876-5649
  • Fax: 610-841-3914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License NumberMD030973E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: