MEDICARE: DR. EMILY WHITE 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	207Q00000X	Family Medicine Physician	0101240694	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	379751	OTHER	VA	ANTHEM

General Provider Information

NPI Number	:	1235276270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EMILY WHITE LIEB MD

Provider Business Mailing Address
First Line	:	3241 WESTERN BRANCH BLVD
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23321-5260
Country	:	US
Telephone Number	:	757-686-3508
Fax Number	:	757-686-0541

Provider Business Practice Location Address
First Line	:	1168 FIRST COLONIAL RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-2426
Country	:	US
Telephone Number	:	757-352-2020
Fax Number	:	757-352-2021

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

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	04/12/2010

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