Provider Demographics
NPI:1538421938
Name:LIBBY, MATTHEW B (DO)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:B
Last Name:LIBBY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 MILL POND DR
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:MA
Mailing Address - Zip Code:02631-2322
Mailing Address - Country:US
Mailing Address - Phone:774-207-7187
Mailing Address - Fax:
Practice Address - Street 1:714 MAIN ST
Practice Address - Street 2:
Practice Address - City:YARMOUTH PORT
Practice Address - State:MA
Practice Address - Zip Code:02675-2000
Practice Address - Country:US
Practice Address - Phone:508-362-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-12
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA261744207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine