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Individual
DR. MARC ANDREW LIEBERMAN
Active
Individual
DR. MARC ANDREW LIEBERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
235614
MA
208000000X
Pediatrics Physician
MD12930
RI
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
Primary
235614
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000776402
RI MEDICARE
RI
01
—
03/08/2011
BCBSRI
RI
01
—
03/10/2011
NHPRI
RI
05
—
110080468A
—
MA
01
—
939025129
RI MEDICARE GROUP
RI
05
—
ML83659
—
RI
Enumeration date
05/11/2007
Last updated
11/10/2020
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