Individual
MR. CHIGOZIE L IBE
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
382 EPPS ST, WIND GAP, PA 18091-9717
(610) 863-8598
Mailing address
995 BUCK DR, NAZARETH, PA 18064-8668
(610) 588-7155
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
25MP00120400
NJ
363A00000X
Physician Assistant
Primary
MA051543
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5005698
KEYSTONE HEALTHPLAN CENTR
PA
Enumeration date
05/01/2006
Last updated
07/08/2007
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