Healthcare Provider Details

I. General information

NPI: 1447374343
Provider Name (Legal Business Name): SAMUEL DAVID CILIBERTO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S VANCE ST
SANFORD NC
27330-4239
US

IV. Provider business mailing address

101 S VANCE ST
SANFORD NC
27330-4239
US

V. Phone/Fax

Practice location:
  • Phone: 919-776-0551
  • Fax: 919-776-0553
Mailing address:
  • Phone: 919-776-0551
  • Fax: 919-776-0553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number19980
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: