Provider Demographics
NPI:1962501866
Name:SIERRA, MAIDA (M D)
Entity type:Individual
Prefix:
First Name:MAIDA
Middle Name:
Last Name:SIERRA
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:MAIDA
Other - Middle Name:
Other - Last Name:SIERRA-NEGRON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:M D
Mailing Address - Street 1:100 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-2301
Mailing Address - Country:US
Mailing Address - Phone:740-594-5000
Mailing Address - Fax:
Practice Address - Street 1:100 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-2301
Practice Address - Country:US
Practice Address - Phone:740-594-5000
Practice Address - Fax:740-592-5402
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0554322084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV4209571Medicare PIN
OHSI4067374Medicare ID - Type Unspecified
E86014Medicare UPIN
WV4209572Medicare PIN