Provider Demographics
NPI:1568467561
Name:LIBERTIN, ANDREW G (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:G
Last Name:LIBERTIN
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 1:7777 HEARTHSTONE AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-6971
Mailing Address - Country:US
Mailing Address - Phone:234-237-9932
Mailing Address - Fax:
Practice Address - Street 1:832 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ORRVILLE
Practice Address - State:OH
Practice Address - Zip Code:44667-2208
Practice Address - Country:US
Practice Address - Phone:330-684-4771
Practice Address - Fax:330-684-2075
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.055141207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4307999OtherAETNA #
OH100013700OtherRR MEDICARE PIN #
OHCC9333OtherRR MEDICARE GROUP #
OH0975888Medicaid
OH341773267DOtherAULTCARE #
OH91656OtherQUALCHOICE #
OH2900613OtherUNITED HEALTHCARE #
OH341773267OtherCOMMERCIA CARRIERS
OH0696064Medicaid
OH000000138316OtherANTHEM BCBS #
OH2735441001OtherCIGNA #
OH34177326700OtherBWC GROUP #
OHCC9333OtherRR MEDICARE GROUP #
OH4307999OtherAETNA #
OH91656OtherQUALCHOICE #