Provider Demographics
NPI:1326053992
Name:NOOR, SIDI Y (MD)
Entity Type:Individual
Prefix:MR
First Name:SIDI
Middle Name:Y
Last Name:NOOR
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 1:142 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:VA
Mailing Address - Zip Code:24266-4636
Mailing Address - Country:US
Mailing Address - Phone:276-889-0433
Mailing Address - Fax:423-581-6638
Practice Address - Street 1:142 HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:VA
Practice Address - Zip Code:24266-4636
Practice Address - Country:US
Practice Address - Phone:276-889-0433
Practice Address - Fax:423-581-6638
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101242704207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4031817OtherBCBS
TNTN0103OtherJOHN DEERE
TN3867737Medicare ID - Type Unspecified
TNTN0103OtherJOHN DEERE