Provider Demographics
NPI:1104871524
Name:SIVILOTTI, MARCO L (MD)
Entity type:Individual
Prefix:
First Name:MARCO
Middle Name:L
Last Name:SIVILOTTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 STUART STREET
Mailing Address - Street 2:EMPIRE 3
Mailing Address - City:KINGSTON
Mailing Address - State:ON
Mailing Address - Zip Code:K7L2V7
Mailing Address - Country:CA
Mailing Address - Phone:613-548-2368
Mailing Address - Fax:
Practice Address - Street 1:76 STUART STREET
Practice Address - Street 2:EMPIRE 3
Practice Address - City:KINGSTON
Practice Address - State:ON
Practice Address - Zip Code:K7L2V7
Practice Address - Country:CA
Practice Address - Phone:613-548-2368
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA153549207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine