Provider Demographics
NPI:1619055019
Name:LIZERBRAM, RICHARD LAWERNCE (DPM)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LAWERNCE
Last Name:LIZERBRAM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2032 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-1051
Mailing Address - Country:US
Mailing Address - Phone:215-855-6500
Mailing Address - Fax:215-368-5355
Practice Address - Street 1:2032 N BROAD ST
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-1051
Practice Address - Country:US
Practice Address - Phone:215-855-6500
Practice Address - Fax:215-368-5355
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002335L213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT72789Medicare UPIN
PA3914900001Medicare NSC
PA410962Medicare ID - Type Unspecified