Healthcare Provider Details

I. General information

NPI: 1427019850
Provider Name (Legal Business Name): TINA TRAN LIEBIG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 10/29/2020
Certification Date: 10/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 JOHN PAUL JONES CIR
PORTSMOUTH VA
23708-2111
US

IV. Provider business mailing address

7640 ARGYLE AVE
NORFOLK VA
23505-1702
US

V. Phone/Fax

Practice location:
  • Phone: 757-953-9011
  • Fax: 904-953-8878
Mailing address:
  • Phone: 904-891-5308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA55993
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: