Provider Demographics
NPI:1487656088
Name:LIEBERMAN, CRAIG (MD)
Entity type:Individual
Prefix:DR
First Name:CRAIG
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 1:400 NELSON BLVD
Mailing Address - Street 2:
Mailing Address - City:KINGSTREE
Mailing Address - State:SC
Mailing Address - Zip Code:29556-2662
Mailing Address - Country:US
Mailing Address - Phone:843-355-5353
Mailing Address - Fax:843-355-5357
Practice Address - Street 1:400 NELSON BLVD
Practice Address - Street 2:
Practice Address - City:KINGSTREE
Practice Address - State:SC
Practice Address - Zip Code:29556-2662
Practice Address - Country:US
Practice Address - Phone:843-355-5353
Practice Address - Fax:843-355-5357
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17138207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC171389Medicaid
SCF063275879Medicare PIN
SC060053584Medicare PIN
SC171389Medicaid
SCF063276287Medicare PIN