Provider Demographics
NPI:1629286059
Name:LIEB, DAVID C (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:C
Last Name:LIEB
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:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-446-5908
Mailing Address - Fax:757-446-7055
Practice Address - Street 1:855 W BRAMBLETON AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1005
Practice Address - Country:US
Practice Address - Phone:757-446-5908
Practice Address - Fax:757-446-7055
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101240097207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAPAROtherCORVEL/CORCARE
VAPAROtherMULTIPLAN
VAPAROtherVA HEALTH NETWORK
VA10049927OtherOPTIMA HEALTH
VA375479OtherANTHEM BC/BS
VAPAROtherUNITED HEALTHCARE/MAMSI
VAPAROtherUSA MANAGED CARE
VAPAROtherFIRST HEALTH COMMERCIAL/SOUTHERN HEALTH/COVENTRY HEALTH
VA-033OtherTRICARE/CHAMPUS
VA1629286059Medicaid
NC5912843Medicaid
VAPAROtherVA PREMIER HEALTH
VAPAROtherAETNA
VAPAROtherCIGNA
VAPAROtherMULTIPLAN
VA375479OtherANTHEM BC/BS