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General NPI Number Information
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NPI Number | 1568415701
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Entity Type | Individual
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Provider Name | PETER J LIEPMANN MD
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Gender | Male
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 01/22/2021
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Provider Practice Location Address
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Address Line | 2319 E WASHINGTON BLVD # 2
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City | PASADENA
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State | CA
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Zip | 91104-1945
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Country | US
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Telephone | 845-797-0950
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Fax |
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Provider Business Mailing Address
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Address Line | 257 S DE LACEY AVE UNIT 1130
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City | PASADENA
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State | CA
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Zip | 91105-4189
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Country | US
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Telephone | 518-302-6006
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | C 89383
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | C 89383
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License Number State | CA
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