Provider Demographics
NPI:1275508830
Name:SIDAROS, MEDHAT FAHMEY (MD)
Entity Type:Individual
Prefix:
First Name:MEDHAT
Middle Name:FAHMEY
Last Name:SIDAROS
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 3544
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27895-3544
Mailing Address - Country:US
Mailing Address - Phone:252-291-8600
Mailing Address - Fax:252-291-6914
Practice Address - Street 1:2402 CAMDEN ST SW
Practice Address - Street 2:SUITE B 500
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-8608
Practice Address - Country:US
Practice Address - Phone:252-291-8600
Practice Address - Fax:252-291-6914
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9600733207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1389YOtherBLUE CROSS
NC5900812Medicaid
G39185Medicare UPIN
NC2040262EMedicare PIN
NC1389YOtherBLUE CROSS