Provider Demographics
NPI:1043629447
Name:DUANE SIBILLY
Entity Type:Organization
Organization Name:DUANE SIBILLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:DUANE
Authorized Official - Middle Name:
Authorized Official - Last Name:SIBILLY
Authorized Official - Suffix:
Authorized Official - Credentials:CSA
Authorized Official - Phone:301-474-0916
Mailing Address - Street 1:7744 MANDAN RD
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2166
Mailing Address - Country:US
Mailing Address - Phone:301-474-0916
Mailing Address - Fax:
Practice Address - Street 1:7744 MANDAN RD
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2166
Practice Address - Country:US
Practice Address - Phone:301-474-0916
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DUANE SIBILLY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-08-11
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty