Provider Demographics
NPI:1750477618
Name:LIEBERMAN, AUBREY (MD)
Entity type:Individual
Prefix:
First Name:AUBREY
Middle Name:
Last Name:LIEBERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1342 BELMONT ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-4436
Mailing Address - Country:US
Mailing Address - Phone:508-580-3330
Mailing Address - Fax:508-580-8633
Practice Address - Street 1:1342 BELMONT ST
Practice Address - Street 2:SUITE 105
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-4436
Practice Address - Country:US
Practice Address - Phone:508-580-3330
Practice Address - Fax:508-580-8633
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA376752084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDB20565101OtherCIGNA
MAC07086OtherBLUE SHIELD
MA037675OtherTUFTS
MA2044447Medicaid
MA0016943OtherNEIGHBORHOOD HEALTH
MA11079OtherHPHC
MA2006500OtherAETNA
MA0500352OtherUNITED HEALTH CARE
MA130022403OtherRR MEDICARE
MANP0173970OtherHEALTH NET
MAC07086Medicare ID - Type UnspecifiedMEDICARE
MAB77117Medicare UPIN