Provider Demographics
NPI:1871598268
Name:LIEB, BRIAN E (DO)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:E
Last Name:LIEB
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1086 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-4305
Mailing Address - Country:US
Mailing Address - Phone:814-410-8300
Mailing Address - Fax:814-410-8331
Practice Address - Street 1:387 THEATRE RD
Practice Address - Street 2:
Practice Address - City:CARROLLTOWN
Practice Address - State:PA
Practice Address - Zip Code:15722-7805
Practice Address - Country:US
Practice Address - Phone:814-344-8477
Practice Address - Fax:814-344-2205
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS009117L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001692565Medicaid
PA001692565Medicaid
PA367288ZH9AMedicare PIN