Healthcare Provider Details

I. General information

NPI: 1255508065
Provider Name (Legal Business Name): FREDERICK S LIEBERMAN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2008
Last Update Date: 03/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 LOCUST ST 2ND FL
PHILADELPHIA PA
19102-3727
US

IV. Provider business mailing address

1521 LOCUST ST 2ND FL
PHILADELPHIA PA
19102-3727
US

V. Phone/Fax

Practice location:
  • Phone: 215-732-3450
  • Fax: 215-545-3360
Mailing address:
  • Phone: 215-732-3450
  • Fax: 215-545-3360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD017500E
License Number StatePA

VIII. Authorized Official

Name: MS. STEPHANIE LIEBERMAN
Title or Position: OFFICE MANAGER
Credential:
Phone: 215-732-3450