Provider Demographics
NPI:1447374343
Name:CILIBERTO, SAMUEL DAVID (MD)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:DAVID
Last Name:CILIBERTO
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 1:101 S VANCE ST
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-4239
Mailing Address - Country:US
Mailing Address - Phone:919-776-0551
Mailing Address - Fax:919-776-0553
Practice Address - Street 1:101 S VANCE ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-4239
Practice Address - Country:US
Practice Address - Phone:919-776-0551
Practice Address - Fax:919-776-0553
Is Sole Proprietor?:No
Enumeration Date:2007-03-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19980207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890204VMedicaid
NC8922490Medicaid
NC22490OtherBLUE CROSS BLUE SHIELD
NC0204VOtherBLUE CROSS BLUE SHIELD GP
NC205425Medicare ID - Type Unspecified
NC890204VMedicaid
NC0204VOtherBLUE CROSS BLUE SHIELD GP