Provider Demographics
NPI:1477510840
Name:SYDNOR, CALVIN HERBERT KIBWE IV (DPM, FACFAS)
Entity Type:Individual
Prefix:DR
First Name:CALVIN
Middle Name:HERBERT KIBWE
Last Name:SYDNOR
Suffix:IV
Gender:M
Credentials:DPM, FACFAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1618 HARDY CASH DR
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-2400
Mailing Address - Country:US
Mailing Address - Phone:757-825-5783
Mailing Address - Fax:757-825-9658
Practice Address - Street 1:1618 HARDY CASH DR
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-2400
Practice Address - Country:US
Practice Address - Phone:757-825-5783
Practice Address - Fax:757-825-9658
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000929213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009300481Medicaid
VA480000421Medicare PIN
VAU50018Medicare UPIN