Provider Demographics
NPI:1760404057
Name:LIEBERMAN, RONALD MICHAEL (DO)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:MICHAEL
Last Name:LIEBERMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 N WEST ST STE 1200
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19801-1058
Mailing Address - Country:US
Mailing Address - Phone:302-233-6916
Mailing Address - Fax:484-631-1315
Practice Address - Street 1:317 W GERMANTOWN PIKE STE 102
Practice Address - Street 2:
Practice Address - City:EAST NORRITON
Practice Address - State:PA
Practice Address - Zip Code:19403-4278
Practice Address - Country:US
Practice Address - Phone:302-233-6916
Practice Address - Fax:484-631-1315
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006878L208100000X, 2081P2900X
NJ25MB06359000208100000X, 2081P2900X
DEC2-0004708208100000X
DEC200047082081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEE70794Medicare UPIN
491876Medicare PIN
DE611484140OtherBCBS
DE1000036294Medicaid
491876Medicare PIN
DE430385OtherCOVENTRY