Provider Demographics
NPI:1639291750
Name:CLAUDIA R. LIBERTIN MD LLC
Entity type:Organization
Organization Name:CLAUDIA R. LIBERTIN MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:LIBERTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-777-9183
Mailing Address - Street 1:PO BOX 6637
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06517-0637
Mailing Address - Country:US
Mailing Address - Phone:203-777-9183
Mailing Address - Fax:293-785-1874
Practice Address - Street 1:6 BUSINESS PARK DR
Practice Address - Street 2:SUITE 204
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-2988
Practice Address - Country:US
Practice Address - Phone:203-777-9183
Practice Address - Fax:203-785-1874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT035637207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC02567Medicare PIN