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General NPI Number Information
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NPI Number | 1821215419
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Entity Type | Individual
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Provider Name | MARC DANIEL SIBELLA D.O.
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Gender | Male
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 05/22/2012
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Provider Practice Location Address
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Address Line | 269 UNION ST
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City | LYNN
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State | MA
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Zip | 01901-1314
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Country | US
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Telephone | 616-252-7200
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Fax |
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Provider Business Mailing Address
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Address Line | 47 BEVERLY AVE
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City | MARBLEHEAD
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State | MA
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Zip | 01945-1303
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Country | US
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Telephone | 616-485-0575
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 238692
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License Number State | MA
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