Healthcare Provider Details

I. General information

NPI: 1346243045
Provider Name (Legal Business Name): VINCENT CIBELLA DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 09/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810A W MAIN ST
GENEVA OH
44041-1219
US

IV. Provider business mailing address

2751 TIMBERLINE DR
CORTLAND OH
44410-9275
US

V. Phone/Fax

Practice location:
  • Phone: 440-466-6353
  • Fax:
Mailing address:
  • Phone: 440-466-6353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number36002567
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: