Healthcare Provider Details

I. General information

NPI: 1487279477
Provider Name (Legal Business Name): PULMONARY CRITICAL CARE & SLEEP PHYSICIANS OF THE MAIN LINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2020
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1088 W BALTIMORE PIKE STE 2202
MEDIA PA
19063-5136
US

IV. Provider business mailing address

1098 W BALTIMORE PIKE STE 3402
MEDIA PA
19063-5139
US

V. Phone/Fax

Practice location:
  • Phone: 484-442-8235
  • Fax: 484-443-8039
Mailing address:
  • Phone: 610-565-3250
  • Fax: 610-892-0948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: GEORGE LIEB
Title or Position: OWNER
Credential: MD
Phone: 610-565-3250