Healthcare Provider Details

I. General information

NPI: 1669418745
Provider Name (Legal Business Name): MARK LIEBREICH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

657 HEACOCK RD
YARDLEY PA
19067-6338
US

IV. Provider business mailing address

41 UNIVERSITY DR SUITE 300
NEWTOWN PA
18940-1873
US

V. Phone/Fax

Practice location:
  • Phone: 215-750-7150
  • Fax: 215-701-0913
Mailing address:
  • Phone: 215-946-1500
  • Fax: 215-946-3417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD044551E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: