Healthcare Provider Details

I. General information

NPI: 1750373353
Provider Name (Legal Business Name): JAMES P. SCIBILIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 10/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 COLLEGE AVE
BEAVER PA
15009-2706
US

IV. Provider business mailing address

250 COLLEGE AVE
BEAVER PA
15009-2706
US

V. Phone/Fax

Practice location:
  • Phone: 724-774-4070
  • Fax: 724-774-2872
Mailing address:
  • Phone: 724-774-4070
  • Fax: 724-774-2872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD032524E
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35073648S
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier01086387
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: