Provider Demographics
NPI:1881778140
Name:SISCU, HARALAMBIE (MD)
Entity type:Individual
Prefix:DR
First Name:HARALAMBIE
Middle Name:
Last Name:SISCU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3273 POTTERSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-4201
Mailing Address - Country:US
Mailing Address - Phone:440-695-0019
Mailing Address - Fax:
Practice Address - Street 1:303 CHESTNUT COMMONS DR
Practice Address - Street 2:MAIL CODE ECC2
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-9607
Practice Address - Country:US
Practice Address - Phone:440-366-9444
Practice Address - Fax:440-204-7856
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35079255207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0143268Medicaid
OHH52745Medicare UPIN