Provider Demographics
NPI:1811953227
Name:LIEBLICH, RICHARD M (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:M
Last Name:LIEBLICH
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 1:502 KINGS HWY N
Mailing Address - Street 2:CHERRY HILL WOMEN'S CENTER
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-1502
Mailing Address - Country:US
Mailing Address - Phone:856-667-5910
Mailing Address - Fax:
Practice Address - Street 1:502 KINGS HWY N
Practice Address - Street 2:CHERRY HILL WOMEN'S CENTER
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-1502
Practice Address - Country:US
Practice Address - Phone:856-667-5910
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05310000207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0569003Medicaid
NJ461808UZDMedicare ID - Type Unspecified
NJE22033Medicare UPIN