MEDICARE: DR. SOPHIA A SIBOLD D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	2102	WV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
8	P00206497	OTHER	WV	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	VAA104451	OTHER	VA	GROUP PTAN
2	8130658	OTHER	WV	MAMSI
3	001714321	OTHER	WV	BC/BS
4	176557	OTHER	WV	ANTHEM BC/BS-UNION
5	176558	OTHER	WV	PETERSTOWN
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	5611053	OTHER	WV	AETNA

General Provider Information

NPI Number	:	1366440661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SOPHIA A SIBOLD D.O.

Provider Business Mailing Address
First Line	:	PO BOX 590
Second Line	:
City	:	UNION
State	:	WV
Zip	:	24983-0590
Country	:	US
Telephone Number	:	304-772-3064
Fax Number	:	304-772-3296

Provider Business Practice Location Address
First Line	:	200 HEALTH CENTER DRIVE
Second Line	:
City	:	UNION
State	:	WV
Zip	:	24983-0000
Country	:	US
Telephone Number	:	304-772-3064
Fax Number	:	304-772-3296

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2005
Last Update Date	:	01/29/2025

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Directions to “ DR. SOPHIA A SIBOLD D.O.” Practice Location

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