Provider Demographics
NPI:1194723841
Name:LAIBSON, PETER ROBERT (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:ROBERT
Last Name:LAIBSON
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 1:840 WALNUT STREET
Mailing Address - Street 2:SUITE 920 ATTN: CORNEAL ASSOCIATES, PC
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5109
Mailing Address - Country:US
Mailing Address - Phone:215-928-3180
Mailing Address - Fax:215-928-3854
Practice Address - Street 1:840 WALNUT STREET
Practice Address - Street 2:SUITE 920 ATTN: CORNEAL ASSOCIATES, PC
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5109
Practice Address - Country:US
Practice Address - Phone:215-928-3180
Practice Address - Fax:215-928-3854
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD008438E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007630720004Medicaid
0005434OtherAETNA
PA016766OtherBLUE SHIELD
PA0007630720004Medicaid
PA016766OtherBLUE SHIELD