Provider Demographics
NPI:1477514206
Name:SIDHOM, MAGDY KAMILE (MD)
Entity Type:Individual
Prefix:DR
First Name:MAGDY
Middle Name:KAMILE
Last Name:SIDHOM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MAGDY
Other - Middle Name:KAMILE
Other - Last Name:SIDHOM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:355 CRAWFORD ST
Mailing Address - Street 2:SUITE 808
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23704-2816
Mailing Address - Country:US
Mailing Address - Phone:757-399-1167
Mailing Address - Fax:757-399-1158
Practice Address - Street 1:355 CRAWFORD ST
Practice Address - Street 2:SUITE 808
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23704-2816
Practice Address - Country:US
Practice Address - Phone:757-399-1157
Practice Address - Fax:757-399-1158
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101040856207L00000X
FLME118562207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B07541Medicare UPIN