Healthcare Provider Details

I. General information

NPI: 1679698641
Provider Name (Legal Business Name): SIBLEY MEDICAL INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 08/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9831 GREENBELT ROAD SUITE 103
LANHAM MD
20706-6224
US

IV. Provider business mailing address

9831 GREENBELT RD SUITE 103
LANHAM MD
20706-2202
US

V. Phone/Fax

Practice location:
  • Phone: 301-937-0188
  • Fax:
Mailing address:
  • Phone: 301-937-0188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberR2462
License Number StateMD

VIII. Authorized Official

Name: FATIATU JOBI
Title or Position: DIRECTOR
Credential:
Phone: 301-237-7023