Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MD431926 | PA |
N | 207QA0401X | Family Doctor - Addiction Medicine | MD431926 | PA |
NPI | 1588622427 |
---|---|
Provider Name | Dr. Magdalena Katarzyna Liebe |
First Address | Mars, PA 16046-2390 |
Second Address | Mars, PA 16046-2390 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2006 |
Last Update Date | 06/07/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
098042 | MEDICARE (01) | PA |
098042ZD7N | PTAN (01) | PA |
101520910 | (05) | PA |
I49070 | (02) | PA |