Provider Demographics
NPI:1376530006
Name:LIBERMAN, MARTIN S (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:S
Last Name:LIBERMAN
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 1:1661 PINE STREET
Mailing Address - Street 2:SAN FRANCISCO TOWERS, OUTPATIENT CLINIC
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-0401
Mailing Address - Country:US
Mailing Address - Phone:415-447-5571
Mailing Address - Fax:415-447-5575
Practice Address - Street 1:1661 PINE STREET
Practice Address - Street 2:SAN FRANCISCO TOWERS, OUTPATIENT CLINIC
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-0401
Practice Address - Country:US
Practice Address - Phone:415-447-5571
Practice Address - Fax:415-447-5575
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG26857207RG0100X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G268570Medicaid
CA00G268570Medicaid
A43117Medicare UPIN