Provider Demographics
NPI:1922005925
Name:CERTIFIED LUNG ASSOCIATES
Entity Type:Organization
Organization Name:CERTIFIED LUNG ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:LIEB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-521-3838
Mailing Address - Street 1:23 W CHESTER PIKE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:RIDLEY PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19078-1629
Mailing Address - Country:US
Mailing Address - Phone:610-521-3838
Mailing Address - Fax:610-521-0202
Practice Address - Street 1:23 W CHESTER PIKE
Practice Address - Street 2:SUITE 201
Practice Address - City:RIDLEY PARK
Practice Address - State:PA
Practice Address - Zip Code:19078-1629
Practice Address - Country:US
Practice Address - Phone:610-521-3838
Practice Address - Fax:610-521-0202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0724197000OtherKEYSTONE
PA0016814180001Medicaid
PA0016814180001Medicaid