Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | MD057250L | PA |
N | 207ND0900X | Dermatopathologist | MD057250L | PA |
N | 207NP0225X | Pediatric Dermatologist | MD057250L | PA |
N | 207NS0135X | Procedural Dermatology | MD057250L | PA |
NPI | 1821030271 |
---|---|
Provider Name | Dr. Amara Ashjian Lieberman |
First Address | Bala Cynwyd, PA 19004-1403 |
Second Address | Bala Cynwyd, PA 19004-1403 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2006 |
Last Update Date | 17/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G12693 | (02) |