Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 6443 | NH |
NPI | 1023095569 |
---|---|
Provider Name | Dr. Mark Liebling |
First Address | Manchester, NH 03102-3730 |
Second Address | Nashua, NH 03060 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2005 |
Last Update Date | 21/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30001403 | (05) | NH |
E23469 | (02) | NH |