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General NPI Number Information
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NPI Number | 1639291750
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Entity Type | Organization
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Legal Business Name | CLAUDIA R. LIBERTIN MD LLC
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Dates
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Enumeration Date | 04/06/2007
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Last Update Date | 07/20/2009
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Provider Practice Location Address
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Address Line | 6 BUSINESS PARK DR SUITE 204
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City | BRANFORD
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State | CT
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Zip | 06405-2988
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Country | US
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Telephone | 203-777-9183
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Fax | 203-785-1874
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Provider Business Mailing Address
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Address Line | PO BOX 6637
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City | HAMDEN
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State | CT
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Zip | 06517-0637
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Country | US
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Telephone | 203-777-9183
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Fax | 293-785-1874
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Authorized Official
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Title or Position | CEO
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Name | DR. CLAUDIA R. LIBERTIN
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Credential | M.D.
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Telephone | 203-777-9183
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 035637
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License Number State | CT
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