Healthcare Provider Details

I. General information

NPI: 1326254012
Provider Name (Legal Business Name): ALLAN DANIEL LIEBERMAN M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7510 N FOREST DR
NORTH CHARLESTON SC
29420-4247
US

IV. Provider business mailing address

7510 N FOREST DR
NORTH CHARLESTON SC
29420-4247
US

V. Phone/Fax

Practice location:
  • Phone: 843-572-1600
  • Fax: 843-572-1795
Mailing address:
  • Phone: 843-572-1600
  • Fax: 843-572-1795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number5267
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number5267
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code2083T0002X
TaxonomyMedical Toxicology (Preventive Medicine) Physician
License Number5267
License Number StateSC
# 4
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number5267
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: