Provider Demographics
NPI:1871798165
Name:LIEBERMAN, GILLIAN
Entity type:Individual
Prefix:DR
First Name:GILLIAN
Middle Name:
Last Name:LIEBERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 WESTERLY RD
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:MA
Mailing Address - Zip Code:02493-1152
Mailing Address - Country:US
Mailing Address - Phone:617-754-3597
Mailing Address - Fax:671-754-2545
Practice Address - Street 1:1 DEACONESS RD
Practice Address - Street 2:WCC RADIOLOGY 3RD FL
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5321
Practice Address - Country:US
Practice Address - Phone:617-754-2597
Practice Address - Fax:617-754-2545
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA502112085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology