Provider Demographics
NPI:1750373353
Name:SCIBILIA, JAMES P (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:P
Last Name:SCIBILIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:PA
Mailing Address - Zip Code:15009-2706
Mailing Address - Country:US
Mailing Address - Phone:724-774-4070
Mailing Address - Fax:724-774-2872
Practice Address - Street 1:250 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-2706
Practice Address - Country:US
Practice Address - Phone:724-774-4070
Practice Address - Fax:724-774-2872
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD032524E208000000X
OH35073648S208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01086387Medicaid
PA198989Medicare ID - Type Unspecified
PAB41155Medicare UPIN