Provider Demographics
NPI:1043496730
Name:DAVID A. LIEB
Entity Type:Organization
Organization Name:DAVID A. LIEB
Other - Org Name:FAMILY FOOT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:LIEB
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:301-695-1010
Mailing Address - Street 1:10 HILLCREST DR
Mailing Address - Street 2:SUITE 25
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-6107
Mailing Address - Country:US
Mailing Address - Phone:301-695-1010
Mailing Address - Fax:301-695-1010
Practice Address - Street 1:10 HILLCREST DR
Practice Address - Street 2:SUITE 25
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-6107
Practice Address - Country:US
Practice Address - Phone:301-695-1010
Practice Address - Fax:301-695-1010
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAVID A LIEB
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-14
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01104332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1043496730OtherFACILITY NPI
MD083088700Medicaid
MD083088700Medicaid
MDT320Medicare PIN
MD1043496730OtherFACILITY NPI