Provider Demographics
NPI:1144423096
Name:LIEBERMAN, JONATHAN IRA (MD, MPT)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:IRA
Last Name:LIEBERMAN
Suffix:
Gender:M
Credentials:MD, MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1148 WILLIAM PENN DR
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-4375
Mailing Address - Country:US
Mailing Address - Phone:215-565-5170
Mailing Address - Fax:
Practice Address - Street 1:1016 CHESTNUT ST
Practice Address - Street 2:THOMAS JEFFERSON UNIVERSITY HOSPITAL
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5010
Practice Address - Country:US
Practice Address - Phone:215-955-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4298312085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology