Provider Demographics
NPI:1750333522
Name:LIEBERMAN, ERIC BRUCE (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:BRUCE
Last Name:LIEBERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1400 FOREST GLEN RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-1459
Mailing Address - Country:US
Mailing Address - Phone:301-681-5700
Mailing Address - Fax:301-681-5599
Practice Address - Street 1:1400 FOREST GLEN RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-1459
Practice Address - Country:US
Practice Address - Phone:301-681-5700
Practice Address - Fax:301-681-5599
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0051817207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD606537OtherMARYLAND CAREFIRST
MD060062711OtherRAILROAD MEDICARE
MD4001818Medicaid
MD5022OtherELDER HEALTH
MD7684192OtherAETNA PROVIDR NUMBER
MDA4700005OtherDC CAREFIRST
MD060062711OtherRAILROAD MEDICARE
MD005579A73Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER