Individual
MARC E. LIEBESKIND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
815 PENNSYLVANIA AVE, FORT WORTH, TX 76104-2294
(817) 321-0390
Mailing address
816 W CANNON ST, FORT WORTH, TX 76104-3194
(817) 321-0404
(469) 522-6837
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
223724-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00287736
RAILROAD MEDICARE
—
Enumeration date
07/18/2005
Last updated
05/08/2023
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