Basic Information
| Provider Information | |||||||||
| NPI: | 1629286059 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LIEB | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 936 | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235010936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574465908 | ||||||||
| FaxNumber: | 7574467055 | ||||||||
| Practice Location | |||||||||
| Address1: | 855 W BRAMBLETON AVE | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235101005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574465908 | ||||||||
| FaxNumber: | 7574467055 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2007 | ||||||||
| LastUpdateDate: | 10/15/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | 0101240097 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | PAR | 01 | VA | CORVEL/CORCARE | OTHER | PAR | 01 | VA | MULTIPLAN | OTHER | PAR | 01 | VA | VA HEALTH NETWORK | OTHER | 10049927 | 01 | VA | OPTIMA HEALTH | OTHER | 375479 | 01 | VA | ANTHEM BC/BS | OTHER | PAR | 01 | VA | UNITED HEALTHCARE/MAMSI | OTHER | PAR | 01 | VA | USA MANAGED CARE | OTHER | PAR | 01 | VA | FIRST HEALTH COMMERCIAL/SOUTHERN HEALTH/COVENTRY HEALTH | OTHER | -033 | 01 | VA | TRICARE/CHAMPUS | OTHER | 1629286059 | 05 | VA | MEDICAID | 5912843 | 05 | NC | MEDICAID | PAR | 01 | VA | VA PREMIER HEALTH | OTHER | PAR | 01 | VA | AETNA | OTHER | PAR | 01 | VA | CIGNA | OTHER |