Provider Demographics
NPI:1336279561
Name:LIBERATI-MITCHELL, MARYANNE THERESA (MD)
Entity Type:Individual
Prefix:MRS
First Name:MARYANNE
Middle Name:THERESA
Last Name:LIBERATI-MITCHELL
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 1:986 KUPULAU DR
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-9202
Mailing Address - Country:US
Mailing Address - Phone:610-566-0993
Mailing Address - Fax:610-566-0993
Practice Address - Street 1:205 FOX LN
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:PA
Practice Address - Zip Code:19086-6225
Practice Address - Country:US
Practice Address - Phone:610-566-0993
Practice Address - Fax:610-566-0993
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039549L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine