Provider Demographics
NPI:1811106891
Name:SIDEY, ATARAH EVE MARTIN (MD)
Entity type:Individual
Prefix:
First Name:ATARAH
Middle Name:EVE MARTIN
Last Name:SIDEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ATARAH
Other - Middle Name:EVE
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3800 EASTSIDE HWY
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MT
Mailing Address - Zip Code:59870-2221
Mailing Address - Country:US
Mailing Address - Phone:406-777-2775
Mailing Address - Fax:406-777-2796
Practice Address - Street 1:3800 EASTSIDE HWY
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MT
Practice Address - Zip Code:59870-2221
Practice Address - Country:US
Practice Address - Phone:406-777-2775
Practice Address - Fax:406-777-2796
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD29451207Q00000X
ORLL16337208D00000X
MT77537207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice