Healthcare Provider Details

I. General information

NPI: 1821030271
Provider Name (Legal Business Name): AMARA ASHJIAN LIEBERMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 12/17/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BALA PLZ SUITE 620
BALA CYNWYD PA
19004-1403
US

IV. Provider business mailing address

1 BALA PLZ SUITE 620
BALA CYNWYD PA
19004-1403
US

V. Phone/Fax

Practice location:
  • Phone: 610-664-3300
  • Fax: 610-664-1151
Mailing address:
  • Phone: 610-664-3300
  • Fax: 610-664-1151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberMD057250L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD057250L
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207NI0002X
TaxonomyClinical & Laboratory Dermatological Immunology Physician
License NumberMD057250L
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License NumberMD057250L
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberMD057250L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: