Provider Demographics
NPI:1063487544
Name:LIEBENTRITT, FRANK J (MD)
Entity type:Individual
Prefix:
First Name:FRANK
Middle Name:J
Last Name:LIEBENTRITT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6427 DOWNHILL DR
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-1067
Mailing Address - Country:US
Mailing Address - Phone:814-838-2146
Mailing Address - Fax:
Practice Address - Street 1:6427 DOWNHILL DR
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-1067
Practice Address - Country:US
Practice Address - Phone:814-838-2146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD032892E207Q00000X
OH35055642207Q00000X
OH35-055642207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000517923OtherANTHEM
OHN391720OtherWELLCARE NONPAR
OH2384085Medicaid
OH000000269047OtherANTHEM
OH2384085Medicaid
OHP00702286Medicare PIN
OHN391720OtherWELLCARE NONPAR
PAB37032Medicare UPIN
OHLE4223072Medicare PIN