Provider Demographics
NPI:1528159092
Name:LIEBERMAN, MARC (MD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:
Last Name:LIEBERMAN
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 1:224 SAN JOSE ST
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-3931
Mailing Address - Country:US
Mailing Address - Phone:831-422-6011
Mailing Address - Fax:831-422-6569
Practice Address - Street 1:224 SAN JOSE ST
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-3931
Practice Address - Country:US
Practice Address - Phone:831-422-6011
Practice Address - Fax:831-422-6569
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC33154207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C331540Medicaid
CA00C331540Medicare ID - Type Unspecified
A35185Medicare UPIN