Provider Demographics
NPI:1659449254
Name:LIEBERMAN, GLENN S (MD)
Entity type:Individual
Prefix:
First Name:GLENN
Middle Name:S
Last Name:LIEBERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:14 MAPLE ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GILFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03249-6580
Mailing Address - Country:US
Mailing Address - Phone:603-528-9100
Mailing Address - Fax:603-524-5743
Practice Address - Street 1:14 MAPLE ST STE 100
Practice Address - Street 2:
Practice Address - City:GILFORD
Practice Address - State:NH
Practice Address - Zip Code:03249-5510
Practice Address - Country:US
Practice Address - Phone:603-522-6163
Practice Address - Fax:603-524-3153
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH10628207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30200430Medicaid
NH30200430Medicaid
NHRE5370Medicare ID - Type Unspecified