Provider Demographics
NPI:1659343739
Name:SIKKA, RISHI (MD)
Entity Type:Individual
Prefix:
First Name:RISHI
Middle Name:
Last Name:SIKKA
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 1:818 HARRISON AVE
Mailing Address - Street 2:DOWLING 1 SOUTH
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2645
Mailing Address - Country:US
Mailing Address - Phone:617-414-4849
Mailing Address - Fax:617-414-7759
Practice Address - Street 1:818 HARRISON AVE
Practice Address - Street 2:DOWLING 1 SOUTH
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2645
Practice Address - Country:US
Practice Address - Phone:617-414-4849
Practice Address - Fax:617-414-7759
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-03
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA213920207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2003317Medicaid
MAA35310Medicare ID - Type Unspecified
MA2003317Medicaid