Provider Demographics
NPI:1922017359
Name:SISIC, ANNA MARIE (NP)
Entity Type:Individual
Prefix:MS
First Name:ANNA
Middle Name:MARIE
Last Name:SISIC
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:ANNA
Other - Middle Name:MARIE
Other - Last Name:MAGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1700 REISTERSTOWN RD 214
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-2920
Mailing Address - Country:US
Mailing Address - Phone:443-929-1478
Mailing Address - Fax:
Practice Address - Street 1:1700 REISTERSTOWN RD
Practice Address - Street 2:STE 214
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-2920
Practice Address - Country:US
Practice Address - Phone:410-356-4779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR151342363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
9680-0061OtherCAREFIRST BCBS OF DC
83-16519OtherEVERCARE
MD412452900Medicaid
902126-02OtherCAREFIRST BCBS OF MD
9680-0061OtherCAREFIRST BCBS OF DC
83-16519OtherEVERCARE
P00726928Medicare PIN