Provider Demographics
NPI:1538223466
Name:DELAWARE INTERVENTIONAL SPINE ASSOCIATES LLC
Entity type:Organization
Organization Name:DELAWARE INTERVENTIONAL SPINE ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:LIEBERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:302-674-8444
Mailing Address - Street 1:1673 S STATE ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-5148
Mailing Address - Country:US
Mailing Address - Phone:302-674-8444
Mailing Address - Fax:302-674-8588
Practice Address - Street 1:1673 S STATE ST
Practice Address - Street 2:SUITE B
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-5148
Practice Address - Country:US
Practice Address - Phone:302-674-8444
Practice Address - Fax:302-674-8588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC200047082081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000036294Medicaid
DEE70794Medicare UPIN
DE1000036294Medicaid