Healthcare Provider Details

I. General information

NPI: 1902002215
Provider Name (Legal Business Name): MATTHEW RION ZIBELMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2007
Last Update Date: 06/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 COTTMAN AVE
PHILADELPHIA PA
19111-2434
US

IV. Provider business mailing address

2450 W HUNTING PARK AVE MED/ONC ASSOC OF FCCC, MGI
PHILADELPHIA PA
19129-1302
US

V. Phone/Fax

Practice location:
  • Phone: 215-728-2500
  • Fax: 215-728-3639
Mailing address:
  • Phone: 215-728-2500
  • Fax: 215-707-3639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number55950
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberMD450356
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: