Provider Demographics
NPI:1356313886
Name:SIBEL, EDWARD
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:
Last Name:SIBEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 EASTERN BLVD
Mailing Address - Street 2:OFFICE 1
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21221-6714
Mailing Address - Country:US
Mailing Address - Phone:410-687-4800
Mailing Address - Fax:
Practice Address - Street 1:404 EASTERN BLVD
Practice Address - Street 2:OFFICE 1
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21221-6714
Practice Address - Country:US
Practice Address - Phone:410-687-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00244174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0977160001Medicare NSC