Active NPI
Carl Nelson Liedman, D.O.
- Family Medicine Physician
- Philadelphia, PA
National Provider Identifier
1164427910
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- OS004520L
- Practice address
- 841 E Hunting Park Ave
Suite 110
Philadelphia, PA 19124-4800 - Phone
- (215) 535-4494
- Fax
- (215) 535-4203
- NPI assigned
- Jun 17, 2005
- Last updated
- Sep 19, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 193400000X | PA | |
| Family Medicine Physician | 207Q00000X | OS004520L | PA | Primary |
Addresses
Primary practice location
841 E Hunting Park Ave
Suite 110
Philadelphia, PA 19124-4800
Mailing address
841 E Hunting Park Ave
Suite 110
Philadelphia, PA 19124-4800
Phone (215) 535-4494
Other identifiers 8
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PA10333 | Other | PA | ELDER HEALTH |
| 6128979 | Other | PA | CIGNA |
| 173358 | Other | PA | BLUE SHIELD |
| 00422 | Other | PA | HEALTH PARTNERS |
| 100008 | Other | PA | KEYSTONE MERCY |
| 108074 | Other | PA | AETNA |
| 0075139402 | Other | PA | AMERICHOICE |
| 110159242 | Other | PA | TRAVELORS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 193400000X | PA | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1118966400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1474243200000",
"number": "1164427910",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "841 E HUNTING PARK AVE",
"address_2": "SUITE 110",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191244800",
"telephone_number": "215-535-4494",
"fax_number": "215-535-4203"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "841 E HUNTING PARK AVE",
"address_2": "SUITE 110",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191244800",
"telephone_number": "215-535-4494",
"fax_number": "215-535-4203"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIEDMAN",
"first_name": "CARL",
"middle_name": "NELSON",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-06-17",
"last_updated": "2016-09-19",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "PA",
"license": "193400000X",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "PA",
"license": "OS004520L",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ELDER HEALTH",
"identifier": "PA10333",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "6128979",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "173358",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH PARTNERS",
"identifier": "00422",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "KEYSTONE MERCY",
"identifier": "100008",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "108074",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERICHOICE",
"identifier": "0075139402",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRAVELORS",
"identifier": "110159242",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.