Provider Demographics
NPI:1740373687
Name:MARAN, LORI LIEBERMAN (MD)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:LIEBERMAN
Last Name:MARAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1551 PROFESSIONAL LN
Mailing Address - Street 2:SUITE 235
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-6972
Mailing Address - Country:US
Mailing Address - Phone:720-494-4700
Mailing Address - Fax:720-494-4706
Practice Address - Street 1:1551 PROFESSIONAL LN
Practice Address - Street 2:SUITE 235
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-6972
Practice Address - Country:US
Practice Address - Phone:720-494-4700
Practice Address - Fax:720-494-4706
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD429489207RR0500X
CO49807207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO31131085Medicaid
CO31131085Medicaid