MEDICARE: DR. ALEXIS SLOAN LIEBERMAN M.D.

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	208000000X	Pediatrics Physician	MD059659L	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	034976	OTHER	PA	MEDICARE PROVIDER NUMBER

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	:	1972551539
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXIS SLOAN LIEBERMAN M.D.

Provider Business Mailing Address
First Line	:	2000 HAMILTON ST
Second Line	:	#109
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130-3814
Country	:	US
Telephone Number	:	215-774-1166
Fax Number	:	215-279-8383

Provider Business Practice Location Address
First Line	:	2000 HAMILTON ST
Second Line	:	#109
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130-3814
Country	:	US
Telephone Number	:	215-774-1166
Fax Number	:	215-279-8383

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

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	02/17/2010

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Directions to “ DR. ALEXIS SLOAN LIEBERMAN M.D.” Practice Location

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