Provider Demographics
NPI:1396787073
Name:SISMANIS, ARISTIDES (MD)
Entity type:Individual
Prefix:DR
First Name:ARISTIDES
Middle Name:
Last Name:SISMANIS
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 1:1201 E MARSHALL ST
Mailing Address - Street 2:P.O. BOX 980146
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23219-2050
Mailing Address - Country:US
Mailing Address - Phone:804-828-3965
Mailing Address - Fax:804-828-5779
Practice Address - Street 1:1201 E MARSHALL ST
Practice Address - Street 2:SUITE 401
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23219-2050
Practice Address - Country:US
Practice Address - Phone:804-628-4368
Practice Address - Fax:804-828-5779
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101032101207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006591515Medicaid
VA040000356Medicare ID - Type Unspecified
VA006591515Medicaid