1710140017 NPI number — DR. LAWRENCE P SCIBILIA MD

Table of content: DR. LAWRENCE P SCIBILIA MD (NPI 1710140017)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710140017 NPI number — DR. LAWRENCE P SCIBILIA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCIBILIA
Provider First Name:
LAWRENCE
Provider Middle Name:
P
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710140017
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/22/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 FRONT ST
Provider Second Line Business Mailing Address:
STE 280
Provider Business Mailing Address City Name:
CONSHOHOCKEN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19428-2891
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
484-351-8459
Provider Business Mailing Address Fax Number:
484-351-8810

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1660 S ALBION ST STE 425
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-267-2404
Provider Business Practice Location Address Fax Number:
484-351-8810
Provider Enumeration Date:
07/07/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  036086467 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X , with the licence number: DR.0059077 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)