Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 6162 | MD |
NPI | 1013051168 |
---|---|
Provider Name | Dr. Jeffrey Alan Lieberman |
First Address | Owings Mills, MD 21117-3056 |
Second Address | Timonium, MD 21093-2226 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2007 |
Last Update Date | 30/07/2012 |