Provider Demographics
NPI:1356338131
Name:LIEBELT, ERICA LYNN (MD)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:LYNN
Last Name:LIEBELT
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 CHADWICK SQUARE CT STE A
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28739-3238
Mailing Address - Country:US
Mailing Address - Phone:828-692-4289
Mailing Address - Fax:828-696-1794
Practice Address - Street 1:110 CHADWICK SQUARE CT STE A
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28739-3238
Practice Address - Country:US
Practice Address - Phone:828-692-4289
Practice Address - Fax:828-696-1794
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2024-03483208000000X, 2080P0204X, 2080T0002X
ARE-139332080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080T0002XAllopathic & Osteopathic PhysiciansPediatricsMedical Toxicology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1356338131Medicaid
AL009920235Medicaid
AL515-19935OtherBCBS
AL009914022Medicaid
AL051519935Medicaid
AL515-15179OtherBCBS
AL515-46207OtherBCBS
AL7624702OtherAETNA
AL7624702OtherAETNA
AL009920235Medicaid