1578762019 NPI number — RICHARD R LIBERTHSON, MD, PC

Table of content: (NPI 1578762019)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578762019 NPI number — RICHARD R LIBERTHSON, MD, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RICHARD R LIBERTHSON, MD, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578762019
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8 HAWTHORNE PL
Provider Second Line Business Mailing Address:
SUITE 110
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02114-2335
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-726-8510
Provider Business Mailing Address Fax Number:
617-726-9839

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8 HAWTHORNE PL
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02114-2335
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-726-8510
Provider Business Practice Location Address Fax Number:
617-742-8446
Provider Enumeration Date:
07/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LIBERTHSON
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
617-726-8510

Provider Taxonomy Codes

  • Taxonomy code: 2080P0202X , with the licence number:  37162 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: 37162 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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