Provider Demographics
NPI:1952430720
Name:MARGARET LIBBY, MD
Entity Type:Organization
Organization Name:MARGARET LIBBY, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:A
Authorized Official - Last Name:LIBBY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-795-3155
Mailing Address - Street 1:1382 QUAKER RD
Mailing Address - Street 2:
Mailing Address - City:BARKER
Mailing Address - State:NY
Mailing Address - Zip Code:14012-9605
Mailing Address - Country:US
Mailing Address - Phone:716-795-3155
Mailing Address - Fax:716-795-3013
Practice Address - Street 1:1382 QUAKER RD
Practice Address - Street 2:
Practice Address - City:BARKER
Practice Address - State:NY
Practice Address - Zip Code:14012-9605
Practice Address - Country:US
Practice Address - Phone:716-795-3155
Practice Address - Fax:716-795-3013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY173735207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0102554OtherIHA
040426003525OtherFIDELIS
000510537001OtherBCBS
NY01086539Medicaid
00020500201OtherUNIVERA
000510537001OtherBCBS
AA0974Medicare ID - Type Unspecified