Healthcare Provider Details

I. General information

NPI: 1336188325
Provider Name (Legal Business Name): PHILIPPE J SIOUFI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 FOREST RD
SALISBURY MA
01952-1603
US

IV. Provider business mailing address

PO BOX 5838
SALISBURY MA
01952-0838
US

V. Phone/Fax

Practice location:
  • Phone: 978-352-2131
  • Fax:
Mailing address:
  • Phone: 978-352-2131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number81620
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: