Provider Demographics
NPI:1073580221
Name:SIDHU, BALJIT S (MD)
Entity Type:Individual
Prefix:
First Name:BALJIT
Middle Name:S
Last Name:SIDHU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1115 BOULDERS PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23225-4067
Mailing Address - Country:US
Mailing Address - Phone:804-560-5595
Mailing Address - Fax:804-560-9029
Practice Address - Street 1:4710 PUDDLEDOCK RD
Practice Address - Street 2:SUITE 100
Practice Address - City:PRINCE GEORGE
Practice Address - State:VA
Practice Address - Zip Code:23875-1237
Practice Address - Country:US
Practice Address - Phone:804-732-0095
Practice Address - Fax:804-732-0055
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2013-12-05
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Provider Licenses
StateLicense IDTaxonomies
VA0101031126204D00000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1073580221OtherMEDICARE RAILROAD
VA006408729Medicaid
VAC09578Medicare PIN
VAB10299Medicare UPIN