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NPI Code Detail

MEDICARE: DR. ANDREW G LIBERTIN M.D.

MEDICARE: DR. ANDREW G LIBERTIN M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RG0100XGastroenterology Physician35.055141OH

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2100013700OTHEROHRR MEDICARE PIN #
3CC9333OTHEROHRR MEDICARE GROUP #

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14307999OTHEROHAETNA #
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5341773267DOTHEROHAULTCARE #
691656OTHEROHQUALCHOICE #
72900613OTHEROHUNITED HEALTHCARE #
8341773267OTHEROHCOMMERCIA CARRIERS
9MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10000000138316OTHEROHANTHEM BCBS #
112735441001OTHEROHCIGNA #
1234177326700OTHEROHBWC GROUP #

General Provider Information

NPI Number : 1568467561
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ANDREW G LIBERTIN M.D.
Provider Business Mailing Address
First Line : 7777 HEARTHSTONE AVE NW
Second Line :
City : CANTON
State : OH
Zip : 44720-6971
Country : US
Telephone Number : 234-237-9932
Fax Number :
Provider Business Practice Location Address
First Line : 832 S MAIN ST
Second Line :
City : ORRVILLE
State : OH
Zip : 44667-2208
Country : US
Telephone Number : 330-684-4771
Fax Number : 330-684-2075
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2005
Last Update Date : 03/18/2024

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