Organization

Liberty Healthcare Llc

Family Medicine Physician in Virginia Beach, VA(View on Map)

Legal Business Name

Liberty Healthcare Llc

NPI Number

1720332349

NPI Type

Organization

Enumeration Date

11/05/2012

Specialties

(Taxonomies)

Code

207Q00000X

Primary Taxonomy

Yes

Licenses

State

Virginia

License Number

140177

Contact
Information

Purpose

Mailing
Location

Address

3454 E STONE MOUNTAIN LN
5589 GREENWICH RD

City

Sandy
Virginia Beach

State

UT
VA

Postal Code

84092-6549
23462-6565

Country

US
US

Telephone Number

(801) 808-2357
(757) 216-9115

Authorized Official

Name

Derk Pardoe

Title or Position

PARTNER

Telephone Number

(801) 808-2357

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 11/05/2012

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