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NPI Code Detail

MEDICARE: MICHAEL D. LIEBERMAN, M.D.,PLLC

MEDICARE: MICHAEL D. LIEBERMAN, M.D.,PLLC
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
1207Q00000XFamily Medicine Physician0101019492VA

General Provider Information

NPI Number : 1790097392
Entity Type Code : Organization
Provider Name (Legal Business Name) : MICHAEL D. LIEBERMAN, M.D.,PLLC
Provider Business Mailing Address
First Line : 7533 LERIC LN
Second Line :
City : ALEXANDRIA
State : VA
Zip : 22306-2412
Country : US
Telephone Number : 703-660-9333
Fax Number : 703-660-9333
Provider Business Practice Location Address
First Line : 2729 KING ST
Second Line :
City : ALEXANDRIA
State : VA
Zip : 22302-4008
Country : US
Telephone Number : 703-836-8838
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. MICHAEL DAVID LIEBERMAN
Credential : MD
Telephone Number : 703-660-9333
Provider Enumeration Date : 07/12/2010
Last Update Date : 12/21/2010

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