Michael Stanley Siuta (NPI# 1740274281, PAC ID# 2567492382) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is GASTROENTEROLOGY.
Nation Provider ID (NPI) | 1740274281 |
PAC ID by PECOS | 2567492382 |
Professional Enrollment ID | I20101109000072 |
Full Name | Michael Stanley Siuta |
Organization Legal Name | LIFEBRIDGE COMMUNITY GASTROENTEROLOGY LLC |
Address |
802 Landmark Dr Suite 129 Glen Burnie MD 21061-9121 |
Phone Number | 4108634899 |
Gender | M |
Medical School | UNIVERSITY OF MARYLAND SCHOOL OF MEDICINE |
Graduation Year | 1993 |
Primary Specialty | GASTROENTEROLOGY |
Group Practice PAC ID | 7618108119 |
Number of Group Practice Members | 24 |
Accepts Medicare Assignment | Y |
Claim Control Number (CCN) | Legal Business Name |
---|---|
210043 | UNIVERSITY OF MD BALTIMORE WASHINGTON MEDICAL CENTER |
210034 | MEDSTAR HARBOR HOSPITAL |
Address | Phone | Organization |
---|---|---|
516 N Rolling Rd, Suite 204, Catonsville, MD 21228-4187 | 4106027782 | LIFEBRIDGE COMMUNITY GASTROENTEROLOGY LLC |
802 Landmark Dr, Suite 129, Glen Burnie, MD 21061-9121 | 4108634899 | LIFEBRIDGE COMMUNITY GASTROENTEROLOGY LLC |
1838 Greene Tree Rd, Suite 400, Pikesville, MD 21208-7103 | 4106027782 | LIFEBRIDGE COMMUNITY GASTROENTEROLOGY LLC |
Organization Legal Name | LIFEBRIDGE COMMUNITY GASTROENTEROLOGY LLC |
Physicians | 22 |
Name | Specialty | Organization | Address |
---|---|---|---|
Christina Fang | Nurse Practitioner | Lifebridge Community Gastroenterology LLC | 1838 Greene Tree Rd, Suite 400, Pikesville, MD 21208-7103 |
Todd Heller | Gastroenterology | Lifebridge Community Gastroenterology LLC | 802 Landmark Dr, Suite 129, Glen Burnie, MD 21061-9121 |
Aminat Oluyemi | Gastroenterology | Lifebridge Community Gastroenterology LLC | 1838 Greene Tree Rd, Suite 400, Pikesville, MD 21208-7103 |
Calvin Parker | Gastroenterology | Lifebridge Community Gastroenterology LLC | 4801 Dorsey Hall Dr, Suite 220, Ellicott City, MD 21042-7749 |
James D Shaffer | Physician Assistant | Lifebridge Community Gastroenterology LLC | 802 Landmark Dr, Suite 129, Glen Burnie, MD 21061-9121 |
Loc Trong Le | Gastroenterology | Lifebridge Community Gastroenterology LLC | 1838 Greene Tree Rd, Suite 180, Pikesville, MD 21208-7100 |
Moncheri H Adebayo | Nurse Practitioner | Lifebridge Community Gastroenterology LLC | 1838 Greene Tree Rd, Suite 400, Pikesville, MD 21208-7103 |
Edward Wolf | Gastroenterology | Lifebridge Community Gastroenterology LLC | 802 Landmark Dr, Suite 129, Glen Burnie, MD 21061-9121 |
Kenolisa C Onwueme | Internal Medicine | Lifebridge Community Gastroenterology LLC | 802 Landmark Dr, Suite 129, Glen Burnie, MD 21061-9121 |
Eric B Blum | Internal Medicine | Lifebridge Community Gastroenterology LLC | 1838 Greene Tree Rd, Suite 180, Pikesville, MD 21208-7100 |
Street Address |
802 LANDMARK DR SUITE 129 |
City | GLEN BURNIE |
State | MD |
Zip | 21061-9121 |
Name | Specialty | Organization | Address |
---|---|---|---|
Todd Heller | Gastroenterology | Lifebridge Community Gastroenterology LLC | 802 Landmark Dr, Suite 129, Glen Burnie, MD 21061-9121 |
James D Shaffer | Physician Assistant | Lifebridge Community Gastroenterology LLC | 802 Landmark Dr, Suite 129, Glen Burnie, MD 21061-9121 |
Edward Wolf | Gastroenterology | Lifebridge Community Gastroenterology LLC | 802 Landmark Dr, Suite 129, Glen Burnie, MD 21061-9121 |
Kenolisa C Onwueme | Internal Medicine | Lifebridge Community Gastroenterology LLC | 802 Landmark Dr, Suite 129, Glen Burnie, MD 21061-9121 |
Arjun Vaid | Gastroenterology | Lifebridge Community Gastroenterology LLC | 802 Landmark Dr, Suite 129, Glen Burnie, MD 21061-9121 |
Ernest Tsao | Gastroenterology | Lifebridge Community Gastroenterology LLC | 802 Landmark Dr, Suite 129, Glen Burnie, MD 21061-9121 |
Name | Specialty | Organization | Address |
---|---|---|---|
Deep Hasmukh Dalal | Rheumatology | 1406 B S Crain Hwy 207, Glen Burnie, MD 21061 | |
Samantha Villanueva | Physical Therapy | Ati Holdings LLC | 7081 -7083 Baltimore Annapolis Blvd, Ati Physical Therapy, Glen Burnie, MD 21061-1431 |
Chinasa Onyeje | Nurse Practitioner | Minute Clinic LLC | 7095 Baltimore Annapolis Blvd, Glen Burnie, MD 21061-1431 |
Carmen Negron-wagman | Physical Therapy | Ati Holdings LLC | 7081 -7083 Baltimore Annapolis Blvd, Ati Physical Therapy, Glen Burnie, MD 21061-1431 |
Leanne Mckoy | Physical Therapy | Ati Holdings LLC | 7081 -7083 Baltimore Annapolis Blvd, Ati Physical Therapy, Glen Burnie, MD 21061-1431 |
John Ohlhaver | Physical Therapy | Ati Holdings LLC | 7081 -7083 Baltimore Annapolis Blvd, Ati Physical Therapy, Glen Burnie, MD 21061-1431 |
Shawn Marie Wallace | Nurse Practitioner | Mdics Rehabilitative Services LLC | 6934 Aviation Blvd, Suite B, Glen Burnie, MD 21061-2593 |
Nadia Koran Krause | Nurse Practitioner | Mdics Rehabilitative Services LLC | 6934 Aviation Blvd, Suite B, Glen Burnie, MD 21061-2593 |
Richard P Campbell | Physician Assistant | Mdics Rehabilitative Services LLC | 6934 Aviation Blvd, Glen Burnie, MD 21061-2593 |
Karen Ann Cousins Brown | Geriatric Medicine | Mdics Rehabilitative Services LLC | 6934 Aviation Blvd, Glen Burnie, MD 21061-2593 |
Find all physicians in zip 21061 |
City | GLEN BURNIE |
Zip Code | 21061 |
Specialty | GASTROENTEROLOGY |
City + Specialty | GLEN BURNIE + GASTROENTEROLOGY |
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Data Provider | Centers for Medicare & Medicaid Services (CMS) |
Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.