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General NPI Number Information
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NPI Number | 1417367855
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Entity Type | Individual
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Provider Name | CHRISTINE IBILIBOR M.D., M.SC.
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Gender | Female
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Dates
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Enumeration Date | 05/07/2014
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Last Update Date | 08/09/2023
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Provider Practice Location Address
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Address Line | 500 RAY C. HUNT DR
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22903
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Country | US
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Telephone | 434-924-9558
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 800422
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22908-0422
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | BP10049568
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 0101272569
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License Number State | VA
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