Provider Demographics
NPI:1164692679
Name:LIEBENTHAL, PETER
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:LIEBENTHAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 U ST NW STE 202
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-7875
Mailing Address - Country:US
Mailing Address - Phone:202-588-5885
Mailing Address - Fax:
Practice Address - Street 1:1115 U ST NW STE 202
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-7875
Practice Address - Country:US
Practice Address - Phone:202-588-5885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-11
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCAC500098171100000X
MDU01696171100000X
VA0121000548171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist