Provider Demographics
NPI:1023021623
Name:LIBBEY, N PETER (MD)
Entity Type:Individual
Prefix:
First Name:N
Middle Name:PETER
Last Name:LIBBEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 CHALKSTONE AVE
Mailing Address - Street 2:ROGER WILLIAMS MEDICAL CENTER/PATHOLOGY DEPT.
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908-4728
Mailing Address - Country:US
Mailing Address - Phone:401-456-2162
Mailing Address - Fax:401-456-2131
Practice Address - Street 1:825 CHALKSTONE AVE
Practice Address - Street 2:ROGER WILLIAMS MEDICAL CENTER/PATHOLOGY DEPT.
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-4728
Practice Address - Country:US
Practice Address - Phone:401-456-2162
Practice Address - Fax:401-456-2131
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD05576207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7002033Medicaid
F09950Medicare UPIN