DR. MARC ANDREW LIEBERMAN M.D. NPI 1366657348

NPI Information

NPI: 1366657348
Provider Name: DR. MARC ANDREW LIEBERMAN, M.D.
Classification: Pediatrics - 2080P0204X
Entity Type: Individual

Specialization: Pediatric Emergency Medicine

PECOS Registration: Yes

Address:
55 LAKE AVE N
WORCESTER, MA
ZIP 01655
Phone: (774) 442-2599
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DR. Marc Andrew Lieberman, M.D. is a pediatric emergency medicine pediatrics in Worcester, MA. The provider is a pediatrician who has special qualifications to manage emergencies in infants and children. DR. Marc Andrew Lieberman, M.D. NPI is 1366657348. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

55 LAKE AVE N
WORCESTER, MA
ZIP 01655-002
Phone: (774) 442-2599
Fax: (774) 442-2510

The NPI 1366657348 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 5/11/2007 and was last updated on 11/10/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	208000000X	Pediatrics		MD12930	RHODE ISLAND	No
2	208000000X	Pediatrics		235614	MASSACHUSETTS	No
3	2080P0204X	Pediatrics	Pediatric Emergency Medicine	235614	MASSACHUSETTS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	000776402	OTHER	RHODE ISLAND	RI MEDICARE
2	03/08/2011	OTHER	RHODE ISLAND	BCBSRI
3	939025129	OTHER	RHODE ISLAND	GROUP RI MEDICARE
4	110080468A	MEDICAID	MASSACHUSETTS
5	03/10/2011	OTHER	RHODE ISLAND	NHPRI
6	939025129	OTHER	RHODE ISLAND	RI MEDICARE GROUP
7	ML83659	MEDICAID	RHODE ISLAND

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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