Provider Demographics
NPI:1457311094
Name:LIBERTY PEDIATRICS AND FAMILY MEDICINE LLC
Entity type:Organization
Organization Name:LIBERTY PEDIATRICS AND FAMILY MEDICINE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:D
Authorized Official - Last Name:HICKEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-340-3560
Mailing Address - Street 1:5963 EXCHANGE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SYKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21784-9256
Mailing Address - Country:US
Mailing Address - Phone:410-549-0900
Mailing Address - Fax:410-549-6121
Practice Address - Street 1:5963 EXCHANGE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:SYKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21784-9256
Practice Address - Country:US
Practice Address - Phone:410-549-0900
Practice Address - Fax:410-549-6121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-27
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD523506500Medicaid
MD2977028Medicaid