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General NPI Number Information
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NPI Number | 1386685089
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Entity Type | Individual
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Provider Name | SAMUEL LIBBER M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/10/2006
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Last Update Date | 10/13/2020
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Provider Practice Location Address
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Address Line | 200 FORBES ST STE 200
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City | ANNAPOLIS
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State | MD
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Zip | 21401-1599
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Country | US
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Telephone | 410-263-6363
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 64316
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City | BALTIMORE
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State | MD
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Zip | 21264-4316
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0205X
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Taxonomy Name | Pediatric Endocrinology Physician
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License Number | D18381
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | D0018381
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License Number State | MD
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