MEDICARE: GEORGE LIEB MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MD040974L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033171087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE LIEB MD

Provider Business Mailing Address
First Line	:	1088 W BALTIMORE PIKE STE 2202
Second Line	:
City	:	MEDIA
State	:	PA
Zip	:	19063-5136
Country	:	US
Telephone Number	:	484-442-8235
Fax Number	:	484-443-8039

Provider Business Practice Location Address
First Line	:	1088 W BALTIMORE PIKE STE 2202
Second Line	:
City	:	MEDIA
State	:	PA
Zip	:	19063-5136
Country	:	US
Telephone Number	:	484-442-8235
Fax Number	:	484-443-8039

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2006
Last Update Date	:	09/19/2022

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Directions to “ GEORGE LIEB MD” Practice Location

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