Provider Demographics
NPI:1235331695
Name:LIEBERMAN, FREDERICK SHEPPARD (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:SHEPPARD
Last Name:LIEBERMAN
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 1:1521 LOCUST STREET
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-6231
Mailing Address - Country:US
Mailing Address - Phone:215-732-3450
Mailing Address - Fax:215-545-3360
Practice Address - Street 1:4979 OLD STREET ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053
Practice Address - Country:US
Practice Address - Phone:215-732-3450
Practice Address - Fax:215-545-3360
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD017500E207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB39921Medicare UPIN
PALI149595Medicare ID - Type Unspecified