Provider Demographics
NPI:1235112822
Name:LIBBY, MARGARET ANN (MD)
Entity Type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:ANN
Last Name:LIBBY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 ELIZABETH DR
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-5226
Mailing Address - Country:US
Mailing Address - Phone:716-438-7235
Mailing Address - Fax:716-795-3013
Practice Address - Street 1:15 ELIZABETH DR
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-5226
Practice Address - Country:US
Practice Address - Phone:716-438-7235
Practice Address - Fax:716-795-3013
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-28
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY17373501207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYML01086539Medicaid
NY00174000000OtherHEALTH CARE PLAN
NY0102554OtherINDEPENDENT HEALTH
NY040426003525OtherFIDELIS
NY0031096OtherGHI
NY00020500201OtherUNIVERA
NY000510537001OtherBLUE CROSS BLUE SHIELD
NY0102554OtherINDEPENDENT HEALTH
NYML01086539Medicaid