Provider Demographics
NPI:1588682082
Name:LALIBERTE, BRIAN JEREMIAH (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:JEREMIAH
Last Name:LALIBERTE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:280 CHESTNUT ST
Mailing Address - Street 2:2ND FL
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01199-1001
Mailing Address - Country:US
Mailing Address - Phone:413-794-5700
Mailing Address - Fax:
Practice Address - Street 1:40 WRIGHT ST
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:MA
Practice Address - Zip Code:01069-1138
Practice Address - Country:US
Practice Address - Phone:413-284-5400
Practice Address - Fax:413-284-5559
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2016-11-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA77527207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
3547830OtherHEALTHSOURCE CMHC
J13781OtherBLUE CROSS BLUE SHIELD
102692OtherCIGNA
277527OtherCONNECTICARE
304004OtherHARVARD PILGRIM
F56349Medicare UPIN
624OtherFALLON COMM HEALTH PLAN
731755OtherTUFTS COMM HEALTH PLAN
999996OtherNETWORK HEALTH
J13781Medicare ID - Type Unspecified
MA3107990Medicaid