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General NPI Number Information
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NPI Number | 1255337002
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Entity Type | Organization
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Legal Business Name | MARK SIVIERI M.D. P.A.
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Dates
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Enumeration Date | 06/27/2005
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Last Update Date | 10/18/2013
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Provider Practice Location Address
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Address Line | 10005 OLD COLUMBIA RD SUITE P170
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City | COLUMBIA
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State | MD
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Zip | 21046-1702
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Country | US
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Telephone | 410-312-5280
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Fax |
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Provider Business Mailing Address
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Address Line | 10005 OLD COLUMBIA RD SUITE P170
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City | COLUMBIA
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State | MD
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Zip | 21046-1702
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Country | US
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Telephone | 410-312-5280
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. LYNN MARIE DUDLEY
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Credential | PA-C
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Telephone | 410-312-5280
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | D0061704
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License Number State | MD
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