NPIMap

Organization Active NPI

Liberty Medical Group PC

  • Family Medicine Physician
  • Philadelphia, PA
National Provider Identifier
1972792257
Registry record updated Nov 1, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OS002144L Issued in PA
Legal business name
LIBERTY MEDICAL GROUP PC
Practice address
6200 Frankford Ave
Philadelphia, PA 19135-3405
Phone
(215) 535-2121
Fax
(215) 535-2860
NPI assigned
Oct 23, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2007

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

Authorized official

Name
Dr. Neil P Glickman, DO
Title
President
Phone
(215) 535-2121

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X OS002144L PA Primary

Addresses

Primary practice location

6200 Frankford Ave
Philadelphia, PA 19135-3405

Mailing address

6200 Frankford Ave
Philadelphia, PA 19135-3405
Phone (215) 535-2121

National Provider Directory

National Provider Directory

Locations

6200 Frankford Ave
Ste 2
Philadelphia, PA 19135
Phone (215) 535-2121

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1193097600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193875200000",
    "number": "1972792257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6200 FRANKFORD AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191353405",
            "telephone_number": "215-535-2121",
            "fax_number": "215-535-2860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6200 FRANKFORD AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191353405",
            "telephone_number": "215-535-2121",
            "fax_number": "215-535-2860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERTY MEDICAL GROUP PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-23",
        "last_updated": "2007-11-01",
        "status": "A",
        "authorized_official_last_name": "GLICKMAN",
        "authorized_official_first_name": "NEIL",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "215-535-2121",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "OS002144L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.