Provider Demographics
NPI:1316046063
Name:SISITSKY, MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:SISITSKY
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 DUDLEY ST.
Mailing Address - Street 2:WOMEN AND INFANTS HOSPITAL-DIVISION OF TRIAGE
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905
Mailing Address - Country:US
Mailing Address - Phone:401-274-1000
Mailing Address - Fax:401-459-1000
Practice Address - Street 1:101 DUDLEY ST.
Practice Address - Street 2:WOMEN AND INFANTS HOSPITAL-DIVISION OF TRIAGE
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905
Practice Address - Country:US
Practice Address - Phone:401-274-1000
Practice Address - Fax:401-459-1000
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH11464207V00000X
MA249289207V00000X
RI14709207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F05411Medicare UPIN
MA002446301Medicare PIN