Healthcare Provider Details

I. General information

NPI: 1477504637
Provider Name (Legal Business Name): OSCAR GLIEBERMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2006
Last Update Date: 02/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 SLATER AVE
PROVIDENCE RI
02906-4834
US

IV. Provider business mailing address

333 SLATER AVE
PROVIDENCE RI
02906-4834
US

V. Phone/Fax

Practice location:
  • Phone: 401-272-5791
  • Fax: 401-621-7339
Mailing address:
  • Phone: 401-272-5791
  • Fax: 401-621-7339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number58196
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number58196
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: