Active NPI
Robert A Liberatore, DPM
- Foot & Ankle Surgery Podiatrist
- Gastonia, NC
National Provider Identifier
1629064969
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Foot & Ankle Surgery Podiatrist
- License
- 296
- Practice address
- 2391 Court Dr
Suite 100
Gastonia, NC 28054-2196 - Phone
- (704) 867-7388
- Fax
- (704) 865-8999
- NPI assigned
- Sep 22, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Foot & Ankle Surgery Podiatrist | 213ES0103X | 296 | NC | Primary |
Addresses
Primary practice location
2391 Court Dr
Suite 100
Gastonia, NC 28054-2196
Mailing address
2391 Court Dr
Suite 100
Gastonia, NC 28054-2196
Phone (704) 867-7388
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 890809B | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 296 | NC | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1127347200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1277164800000",
"number": "1629064969",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2391 COURT DR",
"address_2": "SUITE 100",
"city": "GASTONIA",
"state": "NC",
"postal_code": "280542196",
"telephone_number": "704-867-7388",
"fax_number": "704-865-8999"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2391 COURT DR",
"address_2": "SUITE 100",
"city": "GASTONIA",
"state": "NC",
"postal_code": "280542196",
"telephone_number": "704-867-7388",
"fax_number": "704-865-8999"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIBERATORE",
"first_name": "ROBERT",
"middle_name": "A",
"name_prefix": "Mr.",
"credential": "DPM",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-09-22",
"last_updated": "2010-06-22",
"status": "A"
},
"taxonomies": [
{
"code": "213ES0103X",
"taxonomy_group": "",
"desc": "Podiatrist, Foot & Ankle Surgery",
"state": "NC",
"license": "296",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "890809B",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Gastonia, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.