Organization
LIBERTY STREET INTERNAL MEDICINE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CYNTHIA A YEAGER (ADMINISTRATIVE ASSISTANT)
(814) 336-3506
Entity
Organization
Contact information
Practice address
765 LIBERTY ST, SUITE 301, MEADVILLE, PA 16335-2566
(814) 333-1081
(814) 724-8343
Mailing address
765 LIBERTY ST, SUITE 301, MEADVILLE, PA 16335-2566
(814) 336-3506
(814) 724-8343
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD440871
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MD440871
LICENSE
PA
Enumeration date
09/01/2010
Last updated
09/03/2010
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