Active NPI
Satish Marisiddaiah, DDS
- Dentist
- Upper Darby, PA
National Provider Identifier
1205976370
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DS027000-L
- Practice address
- 653 Long LN
Upper Darby, PA 19082-5230 - Phone
- (610) 623-5295
- Fax
- (610) 623-2979
- NPI assigned
- Feb 7, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Dentist | 122300000X | DS027000-L | PA | Primary |
Addresses
Primary practice location
653 Long LN
Upper Darby, PA 19082-5230
Mailing address
653 Longlane
Upper Darby, PA 19082
Phone (610) 623-5295
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 119271904 | Medicaid | PA | |
| 583471 | Other | PA | UCCI |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DS027000-L | PA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170806400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1205976370",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "653 LONGLANE",
"city": "UPPER DARBY",
"state": "PA",
"postal_code": "19082",
"telephone_number": "610-623-5295",
"fax_number": "610-623-2979"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "653 LONG LN",
"city": "UPPER DARBY",
"state": "PA",
"postal_code": "190825230",
"telephone_number": "610-623-5295",
"fax_number": "610-623-2979"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARISIDDAIAH",
"first_name": "SATISH",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-07",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "PA",
"license": "DS027000-L",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "119271904",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UCCI",
"identifier": "583471",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Upper Darby, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.