MEDICARE: FREDERICK S LIEBERMAN MD PC

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	207X00000X	Orthopaedic Surgery Physician	MD017500E	PA

General Provider Information

NPI Number	:	1255508065
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FREDERICK S LIEBERMAN MD PC

Provider Business Mailing Address
First Line	:	1521 LOCUST ST
Second Line	:	2ND FL
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-3727
Country	:	US
Telephone Number	:	215-732-3450
Fax Number	:	215-545-3360

Provider Business Practice Location Address
First Line	:	1521 LOCUST ST
Second Line	:	2ND FL
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-3727
Country	:	US
Telephone Number	:	215-732-3450
Fax Number	:	215-545-3360

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. STEPHANIE LIEBERMAN
Credential	:
Telephone Number	:	215-732-3450

Provider Enumeration Date	:	05/12/2008
Last Update Date	:	03/24/2011

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