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General NPI Number Information
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NPI Number | 1538223466
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Entity Type | Organization
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Legal Business Name | DELAWARE INTERVENTIONAL SPINE ASSOCIATES LLC
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Dates
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Enumeration Date | 12/22/2006
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Last Update Date | 10/24/2011
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Provider Practice Location Address
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Address Line | 1673 S STATE ST SUITE B
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City | DOVER
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State | DE
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Zip | 19901-5148
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Country | US
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Telephone | 302-674-8444
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Fax | 302-674-8588
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Provider Business Mailing Address
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Address Line | 1673 S STATE ST SUITE B
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City | DOVER
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State | DE
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Zip | 19901-5148
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Country | US
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Telephone | 302-674-8444
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Fax | 302-674-8588
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. RONALD MICHAEL LIEBERMAN
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Credential | D.O.
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Telephone | 302-674-8444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | C20004708
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License Number State | DE
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