Provider Demographics
NPI:1346243045
Name:CIBELLA, VINCENT (DPM)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:
Last Name:CIBELLA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2751 TIMBERLINE DR
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44410-9275
Mailing Address - Country:US
Mailing Address - Phone:440-466-6353
Mailing Address - Fax:
Practice Address - Street 1:810A W MAIN ST
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:OH
Practice Address - Zip Code:44041-1219
Practice Address - Country:US
Practice Address - Phone:440-466-6353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002567213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0773159Medicaid
OH480008272OtherRAILROAD MEDICARE
OH480008272OtherRAILROAD MEDICARE