Provider Demographics
NPI:1942237532
Name:LIEDERMAN, PAUL C (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:C
Last Name:LIEDERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8772 CUYAMACA ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-4218
Mailing Address - Country:US
Mailing Address - Phone:619-258-6397
Mailing Address - Fax:619-448-8586
Practice Address - Street 1:8772 CUYAMACA ST
Practice Address - Street 2:SUITE 104
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-4218
Practice Address - Country:US
Practice Address - Phone:619-258-6397
Practice Address - Fax:619-448-8586
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG78132084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5886402OtherAETNA
CA000G78130Medicaid
CAG7813Medicare ID - Type Unspecified
CA000G78130Medicaid
CA952640984OtherBLUE CROSS