Individual provider Active NPI

Gary A Lieberman, D.P.M.

  • Podiatrist
  • Silver Spring, MD
National Provider Identifier
1336338094
Registry record updated Jan 14, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
00532 Issued in MD
Practice address
10101 Lorain Ave
Silver Spring, MD 20901-2458
Phone
(301) 681-8400
Fax
(301) 681-3339
NPI assigned
Oct 18, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X 00532 MD Primary

Addresses

Primary practice location

10101 Lorain Ave
Silver Spring, MD 20901-2458

Mailing address

10101 Lorain Ave
Silver Spring, MD 20901-2458
Phone (301) 681-8400

Other identifiers 1

IdentifierTypeStateIssuer
790598000MedicaidMD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100806000362 DC Practitioner - Podiatry 7719010065 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Dr. Gary a. Lieberman, P.a. Podiatrist CurrentSince Apr 7, 2010 Accepting new patients
Four Corners Ambulatory Surgical Center LLC PastSince Jun 1, 1994 Accepting new patients

Locations

10313 Georgia Ave
Ste 105
Silver Spring, MD 20902
Phone (301) 593-3500

10101 Lorain Ave
Silver Spring, MD 20901
Phone (301) 681-8400

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1192665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1326499200000",
    "number": "1336338094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10101 LORAIN AVE",
            "city": "SILVER SPRING",
            "state": "MD",
            "postal_code": "209012458",
            "telephone_number": "301-681-8400",
            "fax_number": "301-681-3339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10101 LORAIN AVE",
            "city": "SILVER SPRING",
            "state": "MD",
            "postal_code": "209012458",
            "telephone_number": "301-681-8400",
            "fax_number": "301-681-3339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIEBERMAN",
        "first_name": "GARY",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "D.P.M.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-10-18",
        "last_updated": "2012-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "MD",
            "license": "00532",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "790598000",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Silver Spring, MD

Sources for this page

Verify at the official NPI Registry.