1487620910 NPI number — ROBERT V SIBILIA MD

Table of content: ROBERT V SIBILIA MD (NPI 1487620910)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487620910 NPI number — ROBERT V SIBILIA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIBILIA
Provider First Name:
ROBERT
Provider Middle Name:
V
Provider Name Prefix Text:
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:
1487620910
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/28/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
324 E MILLTOWN ROAD
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
WOOSTER
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44691-1248
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-345-2856
Provider Business Mailing Address Fax Number:
330-345-3756

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
324 E MILLTOWN ROAD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
WOOSTER
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44691-1248
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-345-2856
Provider Business Practice Location Address Fax Number:
330-345-3756
Provider Enumeration Date:
02/24/2006

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: 207RP1001X , with the licence number:  35068478 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RS0012X , with the licence number: 35068478 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 000000142173 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0155755 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3419168938ALL . This is a "HIGHMARK BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: RO0781965 . This is a "MEDICARE SECONDAY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 290012574 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 341916893RS . This is a "SUMMA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4900520001 . This is a "ADMINISTAR FEDERAL" identifier . This identifiers is of the category "OTHER".




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