Provider Demographics
NPI:1386616340
Name:CILIBERTI, DEVIN MARK (MD)
Entity type:Individual
Prefix:
First Name:DEVIN
Middle Name:MARK
Last Name:CILIBERTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 UNIVERSITY PKWY STE 201
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-2973
Mailing Address - Country:US
Mailing Address - Phone:941-359-8300
Mailing Address - Fax:
Practice Address - Street 1:2401 UNIVERSITY PKWY STE 201
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-2973
Practice Address - Country:US
Practice Address - Phone:941-359-8300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-03
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV19661208D00000X
FL151265207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV7306304OtherAETNA
WV001721078OtherMS BCBS
WV1810857000Medicaid
WV7306304OtherAETNA
2030677Medicare PIN
WVWV1159DMedicare PIN
2030674Medicare PIN
2030672Medicare PIN
WV2030678Medicare PIN
2030675Medicare PIN
WV5119271Medicare PIN
WVWV1159CMedicare PIN
WV001721078OtherMS BCBS
2030676Medicare PIN
WV2030679Medicare PIN
WV5119491Medicare PIN
WVWV1159BMedicare PIN
WV1810857000Medicaid
H36436Medicare UPIN
WV511949Medicare PIN