=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356338131
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERICA LYNN LIEBELT MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/05/2005
-----------------------------------------------------
Last Update Date | 03/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 110 CHADWICK SQUARE CT STE A
-----------------------------------------------------
City | HENDERSONVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28739-3238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-692-4289
-----------------------------------------------------
Fax | 828-696-1794
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 110 CHADWICK SQUARE CT STE A
-----------------------------------------------------
City | HENDERSONVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28739-3238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-692-4289
-----------------------------------------------------
Fax | 828-696-1794
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 2024-03483
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2080P0204X
-----------------------------------------------------
Taxonomy Name | Pediatric Emergency Medicine (Pediatrics) Physician
-----------------------------------------------------
License Number | 2024-03483
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 2080T0002X
-----------------------------------------------------
Taxonomy Name | Pediatric Medical Toxicology Physician
-----------------------------------------------------
License Number | 2024-03483
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------