Provider Demographics
NPI:1558457697
Name:LIEBERMAN, CARL MARCUS (MD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:MARCUS
Last Name:LIEBERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:61 LINCOLN ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-8264
Mailing Address - Country:US
Mailing Address - Phone:508-875-6124
Mailing Address - Fax:508-875-9349
Practice Address - Street 1:61 LINCOLN ST
Practice Address - Street 2:SUITE 207
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-8264
Practice Address - Country:US
Practice Address - Phone:508-875-6124
Practice Address - Fax:508-875-9349
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA32268174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1000557OtherEVERCARE
MA82886OtherUSHC
MA19554OtherHARVARD PILGRIM MILF IPA
MA4497OtherFALLON SELECT/DIRECT
MA0017054OtherNEIGHBORHOOD HEALTH
MA20000000209OtherHARVARD PILGRIM MWMC IPA
MA709276OtherTUFTS
MA0151602Medicaid
MAB18142OtherBLUE CROSS BLUE SHEILD
MA1000015OtherUNITED HEALTHCARE
MA23511OtherCHILDRENS MEDICAL SECURIT
MA19554OtherHARVARD PILGRIM MILF IPA
MAA34444Medicare UPIN