Provider Demographics
NPI:1437224110
Name:SIKORSKY, PHYLLIS M (MD)
Entity Type:Individual
Prefix:DR
First Name:PHYLLIS
Middle Name:M
Last Name:SIKORSKY
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 5897
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17004
Mailing Address - Country:US
Mailing Address - Phone:717-935-2161
Mailing Address - Fax:717-935-5666
Practice Address - Street 1:4527 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:PA
Practice Address - Zip Code:17004
Practice Address - Country:US
Practice Address - Phone:717-935-2161
Practice Address - Fax:717-935-5666
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD020628E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006925980002Medicaid
PA0006925980002Medicaid
B32839Medicare UPIN