Provider Demographics
NPI:1578505285
Name:TIBURCIO, CLARA C (MD)
Entity Type:Individual
Prefix:
First Name:CLARA
Middle Name:C
Last Name:TIBURCIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 IRON BRIDGE DR
Mailing Address - Street 2:STE 150
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-2058
Mailing Address - Country:US
Mailing Address - Phone:484-622-6320
Mailing Address - Fax:484-622-6337
Practice Address - Street 1:1 IRON BRIDGE DR STE 150
Practice Address - Street 2:
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426-2058
Practice Address - Country:US
Practice Address - Phone:484-622-6320
Practice Address - Fax:484-622-6337
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD065206L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0102337000OtherIBC - PC/KHPE
PA080135389OtherRRM
PA0017520460001Medicaid
PA1085094OtherKEYSTONE MERCY
PA0102337000OtherAMERIHEALTH/INTERCOUNTY
PA10937644OtherCAQH ID#
PAP1272087OtherOXFORD
PA122330OtherHIGHMARK BLUE SHIELD
PA0175204602OtherAMERICHOICE (UHC MA PLAN)
PA2087354OtherAETNA HMO
PA0900458OtherCIGNA HMO/PPO
PA16452-MD065206LOtherHEALTH PARTNERS
PA5480666OtherAETNA PPO
PA2124456OtherALLIANCE/OPT CHC (MAMSI)
PA500244OtherPHCS
PA0102337000OtherIBC - PC/KHPE