Provider Demographics
NPI:1891754339
Name:LIEBERMAN, LAURA JOY (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:JOY
Last Name:LIEBERMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 BALTIMORE BLVD
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-7098
Mailing Address - Country:US
Mailing Address - Phone:410-876-9680
Mailing Address - Fax:410-386-0876
Practice Address - Street 1:1130 BALTIMORE BLVD
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-7098
Practice Address - Country:US
Practice Address - Phone:410-876-9680
Practice Address - Fax:410-386-0876
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0047306208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD372091800Medicaid
E21591Medicare UPIN