Healthcare Provider Details

I. General information

NPI: 1740221563
Provider Name (Legal Business Name): GLORIA ZIBILICH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 08/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1049 N FRONT ST
PHILIPSBURG PA
16866-8258
US

IV. Provider business mailing address

809 TURNPIKE AVE
CLEARFIELD PA
16830-1232
US

V. Phone/Fax

Practice location:
  • Phone: 814-342-9701
  • Fax: 814-342-7056
Mailing address:
  • Phone: 814-768-2356
  • Fax: 814-768-2134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD046900
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: