Provider Demographics
NPI:1609405547
Name:LIEBERMAN, ALYSON (MD)
Entity type:Individual
Prefix:
First Name:ALYSON
Middle Name:
Last Name:LIEBERMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:933 N WOLFE ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21205-1113
Mailing Address - Country:US
Mailing Address - Phone:410-516-3311
Mailing Address - Fax:410-614-3643
Practice Address - Street 1:933 N WOLFE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21205-1113
Practice Address - Country:US
Practice Address - Phone:401-487-7285
Practice Address - Fax:410-614-3643
Is Sole Proprietor?:No
Enumeration Date:2020-04-03
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0101772207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine