Provider Demographics
NPI:1437481140
Name:LIEBERMAN, HARRY MAX (MD)
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:MAX
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 1:1944 MILAN AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-4635
Mailing Address - Country:US
Mailing Address - Phone:626-487-9310
Mailing Address - Fax:626-441-3159
Practice Address - Street 1:1944 MILAN AVE
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-4635
Practice Address - Country:US
Practice Address - Phone:626-487-9310
Practice Address - Fax:626-441-3159
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-04
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG5980208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics