Healthcare Provider Details

I. General information

NPI: 1538676952
Provider Name (Legal Business Name): MATTHEW CILIMBERG PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2018
Last Update Date: 02/04/2020
Certification Date: 02/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

278 EAGLEVIEW BLVD
EXTON PA
19341-1157
US

IV. Provider business mailing address

61 WHITCHER ST NE STE 4120
MARIETTA GA
30060-1179
US

V. Phone/Fax

Practice location:
  • Phone: 215-552-2818
  • Fax: 484-713-5255
Mailing address:
  • Phone: 770-424-9732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9509
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: