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General NPI Number Information
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NPI Number | 1457311094
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Entity Type | Organization
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Legal Business Name | LIBERTY PEDIATRICS AND FAMILY MEDICINE LLC
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Dates
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Enumeration Date | 03/27/2006
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Last Update Date | 04/23/2025
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Provider Practice Location Address
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Address Line | 5963 EXCHANGE DR SUITE 100
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City | SYKESVILLE
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State | MD
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Zip | 21784-9256
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Country | US
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Telephone | 410-549-0900
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Fax | 410-549-6121
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Provider Business Mailing Address
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Address Line | 5963 EXCHANGE DR SUITE 100
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City | SYKESVILLE
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State | MD
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Zip | 21784-9256
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Country | US
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Telephone | 410-549-0900
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Fax | 410-549-6121
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Authorized Official
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Title or Position | OWNER
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Name | DR. THOMAS D. HICKEY
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Credential | M.D.
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Telephone | 443-340-3560
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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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 |
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License Number State |
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