Provider Demographics
NPI:1922062215
Name:LIEBERSTEIN, LOTH (MD)
Entity Type:Individual
Prefix:DR
First Name:LOTH
Middle Name:
Last Name:LIEBERSTEIN
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 1:10619 PROFESSIONAL CIR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-5831
Mailing Address - Country:US
Mailing Address - Phone:775-852-4848
Mailing Address - Fax:775-850-5763
Practice Address - Street 1:10619 PROFESSIONAL CIR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-5831
Practice Address - Country:US
Practice Address - Phone:775-852-4848
Practice Address - Fax:775-850-5763
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3212207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV20-16011Medicaid
NV103736Medicare PIN
E01221Medicare UPIN