Provider Demographics
NPI:1548217326
Name:LIESER, JOHN DAVID (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DAVID
Last Name:LIESER
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 1:1708 FALL HILL AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-3511
Mailing Address - Country:US
Mailing Address - Phone:540-371-1226
Mailing Address - Fax:540-371-2049
Practice Address - Street 1:1708 FALL HILL AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-3511
Practice Address - Country:US
Practice Address - Phone:540-371-1226
Practice Address - Fax:540-371-2049
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101234782207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00380301OtherMEDICARE RAILROAD
VA010180M38Medicare ID - Type UnspecifiedPROVIDER ID
VAP00380301OtherMEDICARE RAILROAD