Provider Demographics
NPI:1265476170
Name:TSYSINA, MAYA (MD)
Entity Type:Individual
Prefix:
First Name:MAYA
Middle Name:
Last Name:TSYSINA
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:PO BOX 8500-6335
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-6335
Mailing Address - Country:US
Mailing Address - Phone:215-807-8000
Mailing Address - Fax:215-673-0409
Practice Address - Street 1:11726-28 BUSTLETON AVENUE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116
Practice Address - Country:US
Practice Address - Phone:215-677-0501
Practice Address - Fax:215-673-0409
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
PAMD064388L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA16472MD064388LOtherHEALTH PARTNERS
PA520408OtherHIGHMARK BLUE SHIELD
PA0474006000OtherKEYSTONE IBC
PA2033599OtherAETNA
PA01676463Medicaid
PA30079885OtherKEYSTONE MERCY
PA0016764630005Medicaid
PA003902GH2Medicare PIN
PA0474006000OtherKEYSTONE IBC
PAG62192Medicare UPIN