Provider Demographics
NPI:1285680330
Name:LEIBMAN, MATTHEW I (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:I
Last Name:LEIBMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2000 WASHINGTON STREET
Mailing Address - Street 2:BLUE 201
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02462
Mailing Address - Country:US
Mailing Address - Phone:617-965-4263
Mailing Address - Fax:617-928-0597
Practice Address - Street 1:2000 WASHINGTON STREET
Practice Address - Street 2:BLUE 201
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02462
Practice Address - Country:US
Practice Address - Phone:617-965-4263
Practice Address - Fax:617-928-0597
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA220082207XS0106X, 2086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2069491Medicaid
MA2069491Medicaid
MAA36567Medicare ID - Type Unspecified