Provider Demographics
NPI:1356413579
Name:LIEBERMAN, BENJAMIN L (MD)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:L
Last Name:LIEBERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:9 INDUSTRIAL RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-3735
Mailing Address - Country:US
Mailing Address - Phone:508-473-1480
Mailing Address - Fax:508-473-1210
Practice Address - Street 1:77 W MAIN ST
Practice Address - Street 2:SUITE 204
Practice Address - City:HOPKINTON
Practice Address - State:MA
Practice Address - Zip Code:01748-1684
Practice Address - Country:US
Practice Address - Phone:508-435-4414
Practice Address - Fax:508-435-4434
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2013-09-05
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Provider Licenses
StateLicense IDTaxonomies
MA207955207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAH56128Medicare UPIN
MALIA33626Medicare ID - Type Unspecified