Provider Demographics
NPI:1578762019
Name:RICHARD R LIBERTHSON, MD, PC
Entity Type:Organization
Organization Name:RICHARD R LIBERTHSON, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:R
Authorized Official - Last Name:LIBERTHSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-726-8510
Mailing Address - Street 1:8 HAWTHORNE PL
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2335
Mailing Address - Country:US
Mailing Address - Phone:617-726-8510
Mailing Address - Fax:617-726-9839
Practice Address - Street 1:8 HAWTHORNE PL
Practice Address - Street 2:SUITE 110
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2335
Practice Address - Country:US
Practice Address - Phone:617-726-8510
Practice Address - Fax:617-742-8446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-14
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA37162207RC0000X, 2080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Multi-Specialty