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General NPI Number Information
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NPI Number | 1629254271
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Entity Type | Organization
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Legal Business Name | MARCIA A. LIBERATORE, MD PC
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Dates
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Enumeration Date | 01/14/2008
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Last Update Date | 02/25/2011
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Provider Practice Location Address
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Address Line | 917 NW GRANT AVE
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City | CORVALLIS
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State | OR
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Zip | 97330-4570
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Country | US
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Telephone | 541-753-1172
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Fax | 541-752-9935
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Provider Business Mailing Address
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Address Line | PMB 191 922 NW CIRCLE BLVD, STE 160
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City | CORVALLIS
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State | OR
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Zip | 97330-1410
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Country | US
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Telephone | 541-753-1172
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Fax | 541-752-9935
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARCIA ANTOINETTE LIBERATORE
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Credential | MD
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Telephone | 541-753-1172
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | MD24224
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License Number State | OR
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