Healthcare Provider Details

I. General information

NPI: 1184550709
Provider Name (Legal Business Name): LIBERTY MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 TOWN SQUARE DR STE 2
LUSBY MD
20657-6535
US

IV. Provider business mailing address

225 TOWN SQUARE DR STE 2
LUSBY MD
20657-6535
US

V. Phone/Fax

Practice location:
  • Phone: 443-899-9525
  • Fax:
Mailing address:
  • Phone: 443-899-9525
  • Fax: 833-605-7347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SAMUEL NOKURI
Title or Position: OWNER
Credential:
Phone: 240-401-6126