Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | 52659 | MA |
NPI | 1013011592 |
---|---|
Provider Name | Stephen A Lieberman |
First Address | Springfield, MA 01199-1001 |
Second Address | Springfield, MA 01107-1619 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2006 |
Last Update Date | 15/12/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A43812 | (02) | MA |