Provider Demographics
NPI:1376572545
Name:LIEBERMAN, AMANDA (PA)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:LIEBERMAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 S CEDAR CREST BLVD STE 3600
Mailing Address - Street 2:MEDICAL IMAGING OF LEHIGH VALLEY, P.C.
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6364
Mailing Address - Country:US
Mailing Address - Phone:610-770-1606
Mailing Address - Fax:610-740-0560
Practice Address - Street 1:1255 S CEDAR CREST BLVD STE 3600
Practice Address - Street 2:MEDICAL IMAGING OF LEHIGH VALLEY, P.C.
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6364
Practice Address - Country:US
Practice Address - Phone:610-770-1606
Practice Address - Fax:610-740-0560
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY011485-1363A00000X
PAMA052316363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02826882Medicaid
NY8213L18691Medicare PIN
NY02826882Medicaid