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General NPI Number Information
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NPI Number | 1932384518
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Entity Type | Organization
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Legal Business Name | MARK LIBERTIN, MD, INC.
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Dates
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Enumeration Date | 01/02/2008
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Last Update Date | 01/03/2008
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Provider Practice Location Address
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Address Line | 29001 CEDAR RD STE 201
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City | LYNDHURST
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State | OH
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Zip | 44124-4041
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Country | US
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Telephone | 440-605-5900
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Fax |
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Provider Business Mailing Address
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Address Line | 29001 CEDAR RD STE 201
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City | LYNDHURST
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State | OH
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Zip | 44124-4041
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Country | US
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Telephone | 440-605-5900
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK LIBERTIN
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Credential | M.D.
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Telephone | 440-605-5900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VX0000X
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Taxonomy Name | Obstetrics Physician
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License Number | 35055788L
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License Number State | OH
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