Healthcare Provider Details

I. General information

NPI: 1437224110
Provider Name (Legal Business Name): PHYLLIS M SIKORSKY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4527 E MAIN ST
BELLEVILLE PA
17004
US

IV. Provider business mailing address

PO BOX 5897
BELLEVILLE PA
17004
US

V. Phone/Fax

Practice location:
  • Phone: 717-935-2161
  • Fax: 717-935-5666
Mailing address:
  • Phone: 717-935-2161
  • Fax: 717-935-5666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD020628E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: