Provider Demographics
NPI:1467767442
Name:SISCU, MIRELA ALINA (MD)
Entity Type:Individual
Prefix:
First Name:MIRELA
Middle Name:ALINA
Last Name:SISCU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MIRELA
Other - Middle Name:ALINA
Other - Last Name:STOIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3273 POTTERSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-4201
Mailing Address - Country:US
Mailing Address - Phone:440-695-0019
Mailing Address - Fax:
Practice Address - Street 1:5700 COOPER FOSTER PARK RD W
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-4140
Practice Address - Country:US
Practice Address - Phone:440-204-7400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-13
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.121618207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine