Provider Demographics
NPI:1134228794
Name:LIEF, BRUCE ALEXANDER (MD)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:ALEXANDER
Last Name:LIEF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 ARMSTRONG COURT
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087
Mailing Address - Country:US
Mailing Address - Phone:610-722-2999
Mailing Address - Fax:215-333-7295
Practice Address - Street 1:2701 HOLME AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19152
Practice Address - Country:US
Practice Address - Phone:215-333-7293
Practice Address - Fax:215-333-7295
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD013324E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
C31858Medicare UPIN
147982Medicare ID - Type Unspecified