Provider Demographics
NPI:1003924333
Name:SIBLEY, ROSLIND I (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSLIND
Middle Name:I
Last Name:SIBLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ROSLIND
Other - Middle Name:I
Other - Last Name:MCCOY SIBLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2204 EXECUTIVE DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666
Mailing Address - Country:US
Mailing Address - Phone:757-838-1100
Mailing Address - Fax:757-838-3089
Practice Address - Street 1:2204 EXECUTIVE DR
Practice Address - Street 2:SUITE C
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666
Practice Address - Country:US
Practice Address - Phone:757-838-1100
Practice Address - Fax:757-838-3089
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010437722085B0100X, 2085N0700X, 2085P0229X, 2085R0202X, 2085R0204X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
541509240OtherCOMMERCIAL
VA7227922Medicaid
081302OtherANTHEM BLUE CROSS
300000662Medicare ID - Type Unspecified
081302OtherANTHEM BLUE CROSS
300000662Medicare PIN