Provider Demographics
NPI:1952301871
Name:SIVITZ, MARTA E (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTA
Middle Name:E
Last Name:SIVITZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1726 S BROAD ST
Mailing Address - Street 2:STE 101
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19145-2300
Mailing Address - Country:US
Mailing Address - Phone:215-463-3400
Mailing Address - Fax:215-463-3408
Practice Address - Street 1:1726 S BROAD ST
Practice Address - Street 2:STE 101
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19145-2300
Practice Address - Country:US
Practice Address - Phone:215-463-3400
Practice Address - Fax:215-463-3408
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2007-08-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PA012098E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007522840001Medicaid
PA066637EGVMedicare ID - Type Unspecified
PA0007522840001Medicaid