Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | D0018381 | MD |
N | 2080P0205X | Pediatric Endocrinologist | D18381 | MD |
NPI | 1386685089 |
---|---|
Provider Name | Samuel Libber |
First Address | Baltimore, MD 21264-4316 |
Second Address | Annapolis, MD 21401-1599 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2006 |
Last Update Date | 13/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
979441700 | (05) | MD |
B70760 | (02) | MD |