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General NPI Number Information
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NPI Number | 1568467561
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Entity Type | Individual
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Provider Name | ANDREW G LIBERTIN M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/16/2005
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Last Update Date | 03/18/2024
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Provider Practice Location Address
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Address Line | 832 S MAIN ST
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City | ORRVILLE
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State | OH
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Zip | 44667-2208
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Country | US
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Telephone | 330-684-4771
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Fax | 330-684-2075
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Provider Business Mailing Address
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Address Line | 7777 HEARTHSTONE AVE NW
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City | CANTON
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State | OH
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Zip | 44720-6971
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Country | US
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Telephone | 234-237-9932
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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 | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 35.055141
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License Number State | OH
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