Provider Demographics
NPI:1366495079
Name:SIGIDIN, MARINA YAKOVEVNA (MD)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:YAKOVEVNA
Last Name:SIGIDIN
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 1:2 BALA PLAZA, SUITE IL-27
Mailing Address - Street 2:2 NORTH
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1501
Mailing Address - Country:US
Mailing Address - Phone:610-668-9999
Mailing Address - Fax:610-485-4221
Practice Address - Street 1:2 BALA PLAZA, SUITE IL-27
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1501
Practice Address - Country:US
Practice Address - Phone:610-668-9999
Practice Address - Fax:610-859-8217
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD063206L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017054760001Medicaid
PA0017054760001Medicaid
PA015663Medicare PIN