Provider Demographics
NPI:1013977321
Name:LIEBERMAN, JUDY (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:JUDY
Middle Name:
Last Name:LIEBERMAN
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 BUCKMINSTER RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-5807
Mailing Address - Country:US
Mailing Address - Phone:617-731-5715
Mailing Address - Fax:
Practice Address - Street 1:200 LONGWOOD AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5701
Practice Address - Country:US
Practice Address - Phone:617-278-3106
Practice Address - Fax:617-278-3134
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA50012207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B99033Medicare UPIN