MEDICARE: DR. MARTA E SIVITZ MD

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
1	207W00000X	Ophthalmology Physician	012098E	PA

Other Identifiers

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

General Provider Information

NPI Number	:	1952301871
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARTA E SIVITZ MD

Provider Business Mailing Address
First Line	:	1726 S BROAD ST
Second Line	:	STE 101
City	:	PHILA
State	:	PA
Zip	:	19145-2300
Country	:	US
Telephone Number	:	215-463-3400
Fax Number	:	215-463-3408

Provider Business Practice Location Address
First Line	:	1726 S BROAD ST
Second Line	:	STE 101
City	:	PHILA
State	:	PA
Zip	:	19145-2300
Country	:	US
Telephone Number	:	215-463-3400
Fax Number	:	215-463-3408

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	08/03/2007

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Directions to “ DR. MARTA E SIVITZ MD” Practice Location

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