Provider Demographics
NPI:1174517239
Name:LIEBERMAN, EDWIN JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:JAMES
Last Name:LIEBERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:E.
Other - Middle Name:JAMES
Other - Last Name:LIEBERMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5410 CONNECTICUT AVE NW
Mailing Address - Street 2:#113
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20015-2859
Mailing Address - Country:US
Mailing Address - Phone:202-362-3963
Mailing Address - Fax:
Practice Address - Street 1:5410 CONNECTICUT AVE NW
Practice Address - Street 2:#113
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20015-2859
Practice Address - Country:US
Practice Address - Phone:202-362-3963
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC3067174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
178495Medicare ID - Type Unspecified
C62374Medicare UPIN