Provider Demographics
NPI:1346353687
Name:LIEBERMANN, KARL F (DO)
Entity Type:Individual
Prefix:DR
First Name:KARL
Middle Name:F
Last Name:LIEBERMANN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:284 CANTON ST
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02090-2206
Mailing Address - Country:US
Mailing Address - Phone:617-418-0218
Mailing Address - Fax:
Practice Address - Street 1:284 CANTON ST
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:MA
Practice Address - Zip Code:02090-2206
Practice Address - Country:US
Practice Address - Phone:617-418-0218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA249400207Q00000X, 207QA0401X
ME1858207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
4218213OtherAETNA HMO
ME432373499Medicaid
AA3544OtherHARVARD PILGRIM
5996726002OtherCIGNA
MEME1459Medicare PIN
ME432373499Medicaid