MEDICARE: PETER ROBERT LAIBSON 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	207W00000X	Ophthalmology Physician	MD008438E	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
2	0005434	OTHER		AETNA
3	016766	OTHER	PA	BLUE SHIELD

General Provider Information

NPI Number	:	1194723841
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER ROBERT LAIBSON MD

Provider Business Mailing Address
First Line	:	840 WALNUT STREET
Second Line	:	SUITE 920 ATTN: CORNEAL ASSOCIATES, PC
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-5109
Country	:	US
Telephone Number	:	215-928-3180
Fax Number	:	215-928-3854

Provider Business Practice Location Address
First Line	:	840 WALNUT STREET
Second Line	:	SUITE 920 ATTN: CORNEAL ASSOCIATES, PC
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-5109
Country	:	US
Telephone Number	:	215-928-3180
Fax Number	:	215-928-3854

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	07/31/2009

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Directions to “ PETER ROBERT LAIBSON MD” Practice Location

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