Healthcare Provider Details

I. General information

NPI: 1164476016
Provider Name (Legal Business Name): MARIA ANTOINETTE LIMBERAKIS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 03/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9501 ROOSEVELT BLVD SUITE 206 B
PHILADELPHIA PA
19114-1025
US

IV. Provider business mailing address

636 CROSSWICKS ROAD
RYDAL PA
19046
US

V. Phone/Fax

Practice location:
  • Phone: 215-671-8900
  • Fax: 215-671-1272
Mailing address:
  • Phone: 215-817-3577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS004428-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: