1033327846 NPI number — SILWANA SIDORCZUK MD

Table of content: SILWANA SIDORCZUK MD (NPI 1033327846)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033327846 NPI number — SILWANA SIDORCZUK MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIDORCZUK
Provider First Name:
SILWANA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033327846
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/19/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
194 E MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT KENT
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04743-1428
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-728-7300
Provider Business Mailing Address Fax Number:
207-728-7838

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
460 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
MADAWASKA
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04756-1014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-728-7300
Provider Business Practice Location Address Fax Number:
207-728-7838
Provider Enumeration Date:
05/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  MT185132 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 432768599 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200069 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com