Active NPI
Mary Beth Sidorowicz, M.D.
- Anesthesiology Physician
- Westwood, MA
National Provider Identifier
1093763971
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- 79257
- Practice address
- 690 Canton St
Suite 325
Westwood, MA 02090-2321 - Phone
- (781) 407-7713
- Fax
- (781) 407-0998
- NPI assigned
- May 4, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | 79257 | MA | Primary |
Addresses
Primary practice location
690 Canton St
Suite 325
Westwood, MA 02090-2321
Mailing address
690 Canton St
Suite 325
Westwood, MA 02090-2321
Phone (781) 407-7713
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 050519 | Other | MA | TUFTS HELATH PLAN |
| 277194 | Other | MA | HARVARD PILGRIM HEALTHCAR |
| J04288 | Other | MA | BLUE CROSS/BLUE SHIELD |
| 3000320 | Medicaid | MA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 79257 | MA | MD | Anesthesiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146700800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1193702400000",
"number": "1093763971",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "690 CANTON ST",
"address_2": "SUITE 325",
"city": "WESTWOOD",
"state": "MA",
"postal_code": "020902321",
"telephone_number": "781-407-7713",
"fax_number": "781-407-0998"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "690 CANTON ST",
"address_2": "SUITE 325",
"city": "WESTWOOD",
"state": "MA",
"postal_code": "020902321",
"telephone_number": "781-407-7713",
"fax_number": "781-407-0998"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIDOROWICZ",
"first_name": "MARY BETH",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-04",
"last_updated": "2007-10-30",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "MA",
"license": "79257",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TUFTS HELATH PLAN",
"identifier": "050519",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HARVARD PILGRIM HEALTHCAR",
"identifier": "277194",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS/BLUE SHIELD",
"identifier": "J04288",
"state": "MA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3000320",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Westwood, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.