Healthcare Provider Details

I. General information

NPI: 1972551539
Provider Name (Legal Business Name): ALEXIS SLOAN LIEBERMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 02/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 HAMILTON ST #109
PHILADELPHIA PA
19130-3814
US

IV. Provider business mailing address

2000 HAMILTON ST #109
PHILADELPHIA PA
19130-3814
US

V. Phone/Fax

Practice location:
  • Phone: 215-774-1166
  • Fax: 215-279-8383
Mailing address:
  • Phone: 215-774-1166
  • Fax: 215-279-8383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD059659L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: