Individual provider Active NPI

Robert Terrence Liberto, MD

  • Internal Medicine Physician
  • Baltimore, MD
National Provider Identifier
1639193980
Registry record updated Jun 2, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
D0021464 Issued in MD
Practice address
3508 Bank St
Baltimore, MD 21224-2303
Phone
(410) 732-8819
NPI assigned
Jul 27, 2006
Last updated
Jun 2, 2008By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 2, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X D0021464 MD Primary

Addresses

Primary practice location

3508 Bank St
Baltimore, MD 21224-2303

Mailing address

3508 Bank St
Baltimore, MD 21224-2303
Phone (410) 732-8819

Other identifiers 1

IdentifierTypeStateIssuer
786751400MedicaidMD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100324000724 MD Practitioner - Internal Medicine 8921133315 Reassigns benefits to 1 organization
Practice locations: Baltimore,MD, MD

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
D0021464MDMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Maryland Family Care, Inc. Internal Medicine CurrentSince May 1, 2013 Accepting new patients

Locations

7602 Belair Rd
Nottingham, MD 21236
Phone (410) 332-9654

2525 Pot Spring Rd
Timonium, MD 21093
Phone (410) 308-9702

Interoperability endpoints

  • Direct secure messaging: rliberto130979@direct.umm.edu

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1212364800000",
    "number": "1639193980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3508 BANK ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212242303",
            "telephone_number": "410-732-8819"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3508 BANK ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212242303",
            "telephone_number": "410-732-8819"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIBERTO",
        "first_name": "ROBERT",
        "middle_name": "TERRENCE",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-27",
        "last_updated": "2008-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MD",
            "license": "D0021464",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "786751400",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.