Provider Demographics
NPI:1093733164
Name:SCIBETTA, PAUL J JR (DO)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:J
Last Name:SCIBETTA
Suffix:JR
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 1:185 QUEEN CITY AVE
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101-7121
Mailing Address - Country:US
Mailing Address - Phone:603-625-1655
Mailing Address - Fax:603-626-4686
Practice Address - Street 1:185 QUEEN CITY AVE
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-7121
Practice Address - Country:US
Practice Address - Phone:603-625-1655
Practice Address - Fax:603-626-4686
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2232207X00000X
NH9435207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3078110Medicaid
WV3810009486Medicaid
WV612628900OtherBLACK LUNG
WVP00058646OtherRAILROAD MEDICARE
WV811508OtherBSMT
WV3168929OtherUNITED HEALTH CARE
WVP00058646OtherRAILROAD MEDICARE