Provider Demographics
NPI:1760404057
Name:LIEBERMAN, RONALD MICHAEL (DO)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:MICHAEL
Last Name:LIEBERMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2 BALA PLAZA
Mailing Address - Street 2:STE IL9
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1503
Mailing Address - Country:US
Mailing Address - Phone:484-808-4168
Mailing Address - Fax:484-631-1315
Practice Address - Street 1:2 BALA PLAZA
Practice Address - Street 2:STE IL9
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1503
Practice Address - Country:US
Practice Address - Phone:484-808-4168
Practice Address - Fax:484-631-1315
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006878L208100000X
DEC200047082081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEE70794Medicare UPIN
491876Medicare PIN
DE611484140OtherBCBS
DE1000036294Medicaid
491876Medicare PIN
DE430385OtherCOVENTRY