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Provider Information for 1457397770

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DAVID NATHAN LIEBERMAN M.D., PH.D.

Gender: MALE

Individual NPI: 1457397770

Calendar   Last Updated:  2018-09-27
  Certification Date: 

Details

Name Value
NPI 1457397770
Enumeration Date 2006-06-22
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 300 LONGWOOD AVENUE DEPARTMENT OF NEUROLOGY, FEGAN 11
BOSTON, MA 02115-3213
United States

Phone: 617-355-2063 | Fax: 617-730-0288
View Map External Link
Primary Practice Address 300 LONGWOOD AVENUE DEPARTMENT OF NEUROLOGY, FEGAN 11
BOSTON, MA 02115
United States

Phone: 617-355-2063 | Fax: 617-730-0288
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 2084N0402X - Psychiatry & Neurology Neurology with Special Qualifications in Child Neurology MA 268306