Provider Demographics
NPI:1154556140
Name:SIBLEY, MARY
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:SIBLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 MACK BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-5622
Mailing Address - Country:US
Mailing Address - Phone:484-884-0661
Mailing Address - Fax:484-884-0628
Practice Address - Street 1:1200 S. CEDAR CREST BLVD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18105
Practice Address - Country:US
Practice Address - Phone:610-402-8111
Practice Address - Fax:610-402-1698
Is Sole Proprietor?:No
Enumeration Date:2009-05-20
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS016511207P00000X
OH34.011282207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0104723Medicaid
OHH340311OtherMEDICARE PTAN