Lieberman, Marc Andrew

Lieberman, Marc Andrew is an individual health care provider with primary practice located at 55 Lake Ave N , Worcester MA 01655-0002. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pediatrics, Allopathic & Osteopathic Physicians / Pediatric Emergency Medicine. Allopathic & Osteopathic Physicians / Pediatric Emergency Medicine is his primary health care specialty. Lieberman, Marc Andrew can be contacted via phone (774) 442-2599.

Contact Information

Primary practice address
55 Lake Ave N Worcester MA 01655-0002
Phone: (774) 442-2599
Fax: (774) 442-2510
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 235614 Massachusetts
Allopathic & Osteopathic Physicians / Pediatrics 208000000X MD12930 Rhode Island
Allopathic & Osteopathic Physicians / Pediatric Emergency Medicine 2080P0204X 235614 Massachusetts

Profile Details

NPI number 1366657348
LBN Legal business name Lieberman, Marc Andrew
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 11th, 2007
Last updated Nov 10th, 2020 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1366657348 NPPES
Rhode Island Other 03/08/2011 BCBSRI
Rhode Island Other 939025129 BCBSRI
Rhode Island MEDICAID ML83659 BCBSRI
Rhode Island Other 000776402 BCBSRI
Rhode Island Other 939025129 BCBSRI
Rhode Island Other 03/10/2011 BCBSRI
Rhode Island MEDICAID 110080468A BCBSRI

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