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NPI Code Detail

MEDICARE: KELLY M SIDARI

MEDICARE: KELLY M SIDARI
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1386906097
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY M SIDARI
Provider Business Mailing Address
First Line : 425 PENNSYLVANIA AVE
Second Line :
City : ELMIRA
State : NY
Zip : 14904-1762
Country : US
Telephone Number : 607-737-5565
Fax Number : 607-737-2980
Provider Business Practice Location Address
First Line : 425 PENNSYLVANIA AVE
Second Line :
City : ELMIRA
State : NY
Zip : 14904-1762
Country : US
Telephone Number : 607-737-5565
Fax Number : 607-737-2980
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2012
Last Update Date : 06/09/2012

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