Provider Demographics
NPI:1417934142
Name:LIBBEY, CARYN A (MD)
Entity Type:Individual
Prefix:DR
First Name:CARYN
Middle Name:A
Last Name:LIBBEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 HARRISON AVE
Mailing Address - Street 2:YACC BN-C7
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-4001
Mailing Address - Country:US
Mailing Address - Phone:617-414-5405
Mailing Address - Fax:
Practice Address - Street 1:725 ALBANY ST
Practice Address - Street 2:SHAPIRO 7, SUITE B
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2526
Practice Address - Country:US
Practice Address - Phone:617-638-7460
Practice Address - Fax:617-638-5226
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA43031207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0130923Medicaid
NH8111-0208Medicaid
NHNH0208Medicare ID - Type Unspecified
MAB85849Medicare UPIN
MALIA22282Medicare ID - Type Unspecified