Provider Demographics
NPI:1548221690
Name:VONBIBERSTEIN, S E (MD)
Entity Type:Individual
Prefix:
First Name:S
Middle Name:E
Last Name:VONBIBERSTEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2311 DELANEY RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6012
Mailing Address - Country:US
Mailing Address - Phone:910-762-8754
Mailing Address - Fax:910-762-0778
Practice Address - Street 1:2311 DELANEY RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6012
Practice Address - Country:US
Practice Address - Phone:910-762-8754
Practice Address - Fax:910-762-0778
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC36066207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2525526OtherCIGNA PROVIDER NUMBER
NC8901157Medicaid
NC7985120Medicaid
NC59476OtherMEDCOST
CD6751OtherRAIL ROAD MEDICARE GROUP
NC01157OtherBCBS NC GROUP
NC01157OtherBCBS NC GROUP
NC8901157Medicaid
NC7985120Medicaid