Healthcare Provider Details

I. General information

NPI: 1164530861
Provider Name (Legal Business Name): LIBERTY PHYSICIANS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4815 LIBERTY AVE SUITE GR70
PITTSBURGH PA
15224-2156
US

IV. Provider business mailing address

4815 LIBERTY AVE SUITE GR70
PITTSBURGH PA
15224-2156
US

V. Phone/Fax

Practice location:
  • Phone: 412-578-4484
  • Fax:
Mailing address:
  • Phone: 412-578-4484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0200X
TaxonomyOncology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN LISTER
Title or Position: PRESIDENT, LIBERTY PHYSICIANS, P.C.
Credential: M.D.
Phone: 412-578-7135