Provider Demographics
NPI:1033214077
Name:SISTO, JOAN S (MD)
Entity type:Individual
Prefix:DR
First Name:JOAN
Middle Name:S
Last Name:SISTO
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 1:111 NEW HAMPSHIRE AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-2864
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10 MARKET PLACE DR # 3
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:ME
Practice Address - Zip Code:03909-1680
Practice Address - Country:US
Practice Address - Phone:207-305-1959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD15155207N00000X
NH10730207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
2454120OtherAETNA
H09161OtherHARVARD
ME039185OtherANTHEM MAINE
NH01Y002300NH01OtherANTHEM NEW HAMPSHIRE
NHP00321023OtherRAILROAD MEDICARE
ME039185OtherANTHEM MAINE
NH01Y002300NH01OtherANTHEM NEW HAMPSHIRE
NHP00321023OtherRAILROAD MEDICARE