{
"Npi": {
"NPI": "1629254271",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MARCIA A. LIBERATORE, MD PC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PMB 191",
"SecondLineMailingAddress": "922 NW CIRCLE BLVD, STE 160",
"MailingAddressCityName": "CORVALLIS",
"MailingAddressStateName": "OR",
"MailingAddressPostalCode": "97330-1410",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "541-753-1172",
"MailingAddressFaxNumber": "541-752-9935",
"FirstLinePracticeLocationAddress": "917 NW GRANT AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CORVALLIS",
"PracticeLocationAddressStateName": "OR",
"PracticeLocationAddressPostalCode": "97330-4570",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "541-753-1172",
"PracticeLocationAddressFaxNumber": "541-752-9935",
"EnumerationDate": "01/14/2008",
"LastUpdateDate": "02/25/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LIBERATORE",
"AuthorizedOfficialFirstName": "MARCIA",
"AuthorizedOfficialMiddleName": "ANTOINETTE",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "541-753-1172",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QH0100X",
"TaxonomyName": "Health Service Clinic/Center",
"LicenseNumber": "MD24224",
"LicenseNumberStateCode": "OR",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}