Provider Demographics
NPI:1750717955
Name:MCCART SILVIDI, MARTHA (NP)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:MCCART SILVIDI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 S MADISON ST
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47305-2465
Mailing Address - Country:US
Mailing Address - Phone:765-286-7000
Mailing Address - Fax:765-213-2769
Practice Address - Street 1:333 S MADISON ST
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47305-2465
Practice Address - Country:US
Practice Address - Phone:765-286-7000
Practice Address - Fax:765-213-2769
Is Sole Proprietor?:No
Enumeration Date:2013-09-19
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28111528A363LF0000X
IN71004750A364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201188620Medicaid
IN466980008OtherMEDICARE PTAN
IN466980008OtherMEDICARE PTAN
IN202020023Medicare PIN