Provider Demographics
NPI:1952624298
Name:MARK A LIEBERFARB MD PA
Entity Type:Organization
Organization Name:MARK A LIEBERFARB MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:LIEBERFARB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-641-4044
Mailing Address - Street 1:6894 LAKE WORTH RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-2964
Mailing Address - Country:US
Mailing Address - Phone:561-641-4044
Mailing Address - Fax:561-641-8524
Practice Address - Street 1:6894 LAKE WORTH RD
Practice Address - Street 2:SUITE 204
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-2964
Practice Address - Country:US
Practice Address - Phone:561-641-4044
Practice Address - Fax:561-641-8524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-01
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0048840208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL049369400Medicaid
FL049369400Medicaid
FL1063407724Medicare NSC