Individual
BRADLEY NEAL LIBENSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
6C SCHOOL ST, BERWICK, ME 03901
(207) 698-7900
(207) 698-7977
Mailing address
PO BOX 719, BERWICK, ME 03901
(207) 698-7900
(207) 698-7977
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
1276
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
043568
ANTHEM
ME
01
—
04YP12588NH01
ANTHEM
NH
01
—
1078882
CIGNA
ME
05
—
174580000
—
ME
05
—
30202194
—
NH
Enumeration date
11/08/2006
Last updated
04/18/2014
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