Provider Demographics
NPI:1033327846
Name:SIDORCZUK, SILWANA (MD)
Entity Type:Individual
Prefix:
First Name:SILWANA
Middle Name:
Last Name:SIDORCZUK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:194 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FORT KENT
Mailing Address - State:ME
Mailing Address - Zip Code:04743-1428
Mailing Address - Country:US
Mailing Address - Phone:207-728-7300
Mailing Address - Fax:207-728-7838
Practice Address - Street 1:460 MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:MADAWASKA
Practice Address - State:ME
Practice Address - Zip Code:04756-1014
Practice Address - Country:US
Practice Address - Phone:207-728-7300
Practice Address - Fax:207-728-7838
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT185132207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432768599Medicaid
200069OtherANTHEM
ME432768599Medicaid