Provider Demographics
NPI:1629064969
Name:LIBERATORE, ROBERT A (DPM)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:A
Last Name:LIBERATORE
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:2391 COURT DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-2196
Mailing Address - Country:US
Mailing Address - Phone:704-867-7388
Mailing Address - Fax:704-865-8999
Practice Address - Street 1:2391 COURT DR
Practice Address - Street 2:SUITE 100
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2196
Practice Address - Country:US
Practice Address - Phone:704-867-7388
Practice Address - Fax:704-865-8999
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2010-06-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC296213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890809BMedicaid
NC890809BMedicaid