Provider Demographics
NPI:1023017654
Name:DR. GARY A. LIEBERMAN, P.A.
Entity Type:Organization
Organization Name:DR. GARY A. LIEBERMAN, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:M
Authorized Official - Last Name:BECK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:301-681-8400
Mailing Address - Street 1:10101 LORAIN AVE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-2458
Mailing Address - Country:US
Mailing Address - Phone:301-681-8400
Mailing Address - Fax:301-681-3339
Practice Address - Street 1:10101 LORAIN AVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-2458
Practice Address - Country:US
Practice Address - Phone:301-681-8400
Practice Address - Fax:301-681-3339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-15
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00532213E00000X, 213EP1101X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1029860001Medicare NSC
MD183916Medicare PIN
MD183916Medicare PIN