Provider Demographics
NPI:1871644781
Name:LIEBERMAN, SCOTT H (MD)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:H
Last Name:LIEBERMAN
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 1:4323 CAROTHERS PKWY
Mailing Address - Street 2:SUTIE 409
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-5914
Mailing Address - Country:US
Mailing Address - Phone:615-435-7780
Mailing Address - Fax:615-435-7789
Practice Address - Street 1:4323 CAROTHERS PKWY
Practice Address - Street 2:SUTIE 409
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-5914
Practice Address - Country:US
Practice Address - Phone:615-435-7780
Practice Address - Fax:615-435-7789
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000024630207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3077741Medicaid
TN3077741Medicaid
TN3077741Medicare ID - Type Unspecified