Provider Demographics
NPI:1194783290
Name:LIEBMAN, IRVIN M (MD)
Entity type:Individual
Prefix:
First Name:IRVIN
Middle Name:M
Last Name:LIEBMAN
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 1:1306 STEAMBOAT STATION
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966
Mailing Address - Country:US
Mailing Address - Phone:215-322-7542
Mailing Address - Fax:215-322-7542
Practice Address - Street 1:205 NEW TOWN ROAD
Practice Address - Street 2:SUITE 216
Practice Address - City:WARMINSTER
Practice Address - State:PA
Practice Address - Zip Code:18974
Practice Address - Country:US
Practice Address - Phone:215-441-0999
Practice Address - Fax:215-441-3750
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD028206L207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
132105Medicare ID - Type Unspecified
B32425Medicare UPIN