Provider Demographics
NPI:1972551539
Name:LIEBERMAN, ALEXIS SLOAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXIS
Middle Name:SLOAN
Last Name:LIEBERMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 HAMILTON ST
Mailing Address - Street 2:#109
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-3814
Mailing Address - Country:US
Mailing Address - Phone:215-774-1166
Mailing Address - Fax:215-279-8383
Practice Address - Street 1:2000 HAMILTON ST
Practice Address - Street 2:#109
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130-3814
Practice Address - Country:US
Practice Address - Phone:215-774-1166
Practice Address - Fax:215-279-8383
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD059659L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017846850001Medicaid
PA034976OtherMEDICARE PROVIDER NUMBER
PAH09644Medicare UPIN