Provider Demographics
NPI:1033171087
Name:LIEB, GEORGE (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:LIEB
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 1:1088 W BALTIMORE PIKE STE 2202
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-5136
Mailing Address - Country:US
Mailing Address - Phone:484-442-8235
Mailing Address - Fax:484-443-8039
Practice Address - Street 1:1088 W BALTIMORE PIKE STE 2202
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-5136
Practice Address - Country:US
Practice Address - Phone:484-442-8235
Practice Address - Fax:484-443-8039
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD040974L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1276120Medicaid
F16881Medicare UPIN
PA1276120Medicaid