Liberty Pediatrics and Family Medicine LLC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

LIBERTY PEDIATRICS AND FAMILY MEDICINE LLC

Practice address

5963 Exchange Dr
Suite 100
Sykesville, MD 21784-9256

Phone

(410) 549-0900

Fax

(410) 549-6121

NPI assigned

Mar 27, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Thomas D. Hickey, M.D.

Title

Owner

Phone

(443) 340-3560

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Liberty Pediatrics LLC Former legal business name

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Liberty Pediatrics2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Liberty Pediatrics, LLC

  • Clinic/Center
  • Eldersburg, MD
  • NPI 1568860294
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Manuel J Datiles IV, M.D.

  • Pediatrics Physician
  • Eldersburg, MD
  • NPI 1043577000
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1143417600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745366400000",
    "number": "1457311094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5963 EXCHANGE DR",
            "address_2": "SUITE 100",
            "city": "SYKESVILLE",
            "state": "MD",
            "postal_code": "217849256",
            "telephone_number": "410-549-0900",
            "fax_number": "410-549-6121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5963 EXCHANGE DR",
            "address_2": "SUITE 100",
            "city": "SYKESVILLE",
            "state": "MD",
            "postal_code": "217849256",
            "telephone_number": "410-549-0900",
            "fax_number": "410-549-6121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERTY PEDIATRICS AND FAMILY MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-27",
        "last_updated": "2025-04-23",
        "status": "A",
        "authorized_official_last_name": "HICKEY",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "443-340-3560",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "523506500",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2977028",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Liberty Pediatrics LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Lisa Lavitt, LCSWC
• Gregory James Lazzaro, LPMT, MT-BC
• Legacy Treatment LLC
• Jessie Ann Lewis Bettendorf, LGPC
• Liberty Chiropractic LLC
• Lifebridge Primary Care of Eldersburg, LLC
• Lifetime Dental Care of Maryland, Badger, P.C.
• Listen, Speak and Communicate Speech Language Pathology
• Livewell Therapy Services, LLC
• Brianna Lubinski, BSN RN

• Pediatrics Physician in Sykesville, MD
• Providers in Sykesville, MD by specialty
• Pediatrics Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.