Provider Demographics
NPI:1336338094
Name:LIEBERMAN, GARY A (DPM)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:A
Last Name:LIEBERMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10101 LORAIN AVE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-2458
Mailing Address - Country:US
Mailing Address - Phone:301-681-8400
Mailing Address - Fax:301-681-3339
Practice Address - Street 1:10101 LORAIN AVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-2458
Practice Address - Country:US
Practice Address - Phone:301-681-8400
Practice Address - Fax:301-681-3339
Is Sole Proprietor?:No
Enumeration Date:2007-10-18
Last Update Date:2012-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00532213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD790598000Medicaid
MDT31091Medicare UPIN
MD790598000Medicaid