Provider Demographics
NPI:1942266580
Name:LIQUETE, MARIA T (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:T
Last Name:LIQUETE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:213 S JEFFERSON ST STE 625
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24011-1713
Mailing Address - Country:US
Mailing Address - Phone:540-224-5516
Mailing Address - Fax:540-224-5684
Practice Address - Street 1:2900 TYLER RD
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-6374
Practice Address - Country:US
Practice Address - Phone:540-731-7311
Practice Address - Fax:540-731-7377
Is Sole Proprietor?:No
Enumeration Date:2006-04-22
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN394902084P0800X
VA01012443572084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3331589Medicaid
WI1435-320Medicaid
TN3331581Medicaid
TN4114432OtherBCBS
VA021431W82Medicare PIN
TN103I263080Medicare PIN