Healthcare Provider Details

I. General information

NPI: 1124364294
Provider Name (Legal Business Name): MARGARET MARY LIBONATI M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2012
Last Update Date: 12/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7277 BAUSCH ROAD
NEW TRIPOLI PA
18066-0224
US

IV. Provider business mailing address

PO BOX 224 7277 BAUSCH ROAD
NEW TRIPOLI PA
18066-0224
US

V. Phone/Fax

Practice location:
  • Phone: 610-298-2382
  • Fax:
Mailing address:
  • Phone: 610-298-2382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberMD008950E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: