Provider Demographics
NPI:1376733121
Name:CENTER FOR OCCUPATIONAL AND ENVIRONMENTAL MEDICINE
Entity Type:Organization
Organization Name:CENTER FOR OCCUPATIONAL AND ENVIRONMENTAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:LIEBERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-572-1600
Mailing Address - Street 1:7510 NORTHFOREST 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 NORTHFOREST 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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No2083T0002XAllopathic & Osteopathic PhysiciansPreventive MedicineMedical ToxicologyGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD17499Medicare UPIN
SCH93281Medicare UPIN