Organization
FAIRMOUNT PEDIATRICS AND ADOLESCENT MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALEXIS S LIEBERMAN M.D. (MEMBER MANAGER)
(215) 774-1166
Entity
Organization
Contact information
Practice address
2000 HAMILTON ST, #109, PHILA, PA 19130-3814
(215) 774-1166
(215) 279-8383
Mailing address
7042 GREENE ST, PHILA, PA 19119-3439
(215) 990-6625
(215) 279-8383
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
MD059659L
PA
Other
Enumeration date
09/15/2009
Last updated
09/15/2009
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