Provider Demographics
NPI:1154326965
Name:TROGDON, SIDNEY DONALD (MD)
Entity Type:Individual
Prefix:DR
First Name:SIDNEY
Middle Name:DONALD
Last Name:TROGDON
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:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-344-1600
Mailing Address - Fax:859-344-0091
Practice Address - Street 1:20 MEDICAL VILLAGE DR
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017
Practice Address - Country:US
Practice Address - Phone:859-344-1600
Practice Address - Fax:859-344-0091
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY33770208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64337702Medicaid
KY7100056850Medicaid
020054356OtherRAILROAD MEDICARE
OH2431836Medicaid
OH2469136Medicaid
KYP00670399OtherRAIL ROAD MEDICARE
KYE41804Medicare UPIN
KY0969410Medicare PIN
OH2469136Medicaid
KY7100056850Medicaid
KY3313264Medicare PIN
KYP00670399Medicare PIN
OH2431836Medicaid
KY1459526Medicare PIN
KY020054356Medicare PIN