Provider Demographics
NPI:1326254012
Name:LIEBERMAN, ALLAN DANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:DANIEL
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 1:7510 N FOREST DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29420-4247
Mailing Address - Country:US
Mailing Address - Phone:843-572-1600
Mailing Address - Fax:843-572-1795
Practice Address - Street 1:7510 N FOREST DR
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29420-4247
Practice Address - Country:US
Practice Address - Phone:843-572-1600
Practice Address - Fax:843-572-1795
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5267207RA0201X, 2083P0500X, 2083T0002X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Not Answered2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Not Answered2083T0002XAllopathic & Osteopathic PhysiciansPreventive MedicineMedical Toxicology
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD17499Medicare UPIN