Individual
DR. MARK H LIBENSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
300 LONGWOOD AVE, FEGAN 9, BOSTON, MA 02115-5724
(617) 355-8071
(617) 730-0463
Mailing address
300 LONGWOOD AVE, FEGAN 9, BOSTON, MA 02115-5724
(617) 355-8071
(617) 730-0463
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
60519
MA
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
60519
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3076580
—
MA
Enumeration date
07/18/2006
Last updated
08/24/2007
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