Provider Demographics
NPI:1548254337
Name:LIVERMAN, JOSEPH T (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:T
Last Name:LIVERMAN
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 1:111 W CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27856-1327
Mailing Address - Country:US
Mailing Address - Phone:252-459-4012
Mailing Address - Fax:252-459-9773
Practice Address - Street 1:111 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:NC
Practice Address - Zip Code:27856-1327
Practice Address - Country:US
Practice Address - Phone:252-459-4012
Practice Address - Fax:252-459-9773
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9838207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8952310Medicaid
NC80062827OtherRAILROAD MEDICARE
NC4693185OtherCIGNA HEALTHCARE
NC52310OtherBCBSNC
NC27143OtherMEDCOST
NC4693185OtherCIGNA HEALTHCARE
NC200492AMedicare PIN