Provider Demographics
NPI:1386873990
Name:LIEBOLD, LINDA J (PA)
Entity type:Individual
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First Name:LINDA
Middle Name:J
Last Name:LIEBOLD
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Gender:F
Credentials:PA
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Mailing Address - Street 1:5716 CLEVELAND ST STE 200
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-1784
Mailing Address - Country:US
Mailing Address - Phone:757-490-4802
Mailing Address - Fax:757-961-9767
Practice Address - Street 1:5716 CLEVELAND ST STE 200
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-1784
Practice Address - Country:US
Practice Address - Phone:757-490-4802
Practice Address - Fax:757-961-9767
Is Sole Proprietor?:No
Enumeration Date:2009-07-06
Last Update Date:2023-04-18
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant