Healthcare Provider Details

I. General information

NPI: 1063487544
Provider Name (Legal Business Name): FRANK J. LIEBENTRITT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2006
Last Update Date: 06/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6427 DOWNHILL DR
ERIE PA
16505-1067
US

IV. Provider business mailing address

6427 DOWNHILL DR
ERIE PA
16505-1067
US

V. Phone/Fax

Practice location:
  • Phone: 814-838-2146
  • Fax:
Mailing address:
  • Phone: 814-838-2146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD032892E
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35055642
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35-055642
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: