Provider Demographics
NPI:1528036902
Name:CIBAS, EDMUND SAULIUS (MD)
Entity Type:Individual
Prefix:
First Name:EDMUND
Middle Name:SAULIUS
Last Name:CIBAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:75 FRANCIS ST
Mailing Address - Street 2:BRIGHAM AND WOMENS HOSPITAL DEPT OF PATHOLOGY
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115
Mailing Address - Country:US
Mailing Address - Phone:617-732-6797
Mailing Address - Fax:
Practice Address - Street 1:75 FRANCIS ST
Practice Address - Street 2:BRIGHAM AND WOMENS HOSPITAL DEPT OF PATHOLOGY
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:617-732-6797
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA54212207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
730580OtherTUFTS PROVIDER NUMBER
2382808OtherAETNA US HEALTH #
07220029912OtherRRM GROUP SPECIFIC PROVID
07A59029BWHTOtherHARVARD PILGRIM HEALTH CA
J06277OtherBLUE SHIELD ID #
1100036OtherUHC NUMBER
6419602OtherCIGNA NUMBER
A59029Medicare UPIN
J06277Medicare ID - Type Unspecified