Provider Demographics
NPI:1508063868
Name:SIDHAR, RAMAN MANOHAR (MD)
Entity Type:Individual
Prefix:
First Name:RAMAN
Middle Name:MANOHAR
Last Name:SIDHAR
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 1:2210 E HIGHLAND AVE
Mailing Address - Street 2:SUITE # 200
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-4671
Mailing Address - Country:US
Mailing Address - Phone:909-864-1097
Mailing Address - Fax:909-425-8242
Practice Address - Street 1:2210 E HIGHLAND AVE
Practice Address - Street 2:SUITE # 200
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-4671
Practice Address - Country:US
Practice Address - Phone:909-864-1097
Practice Address - Fax:909-425-8242
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA98293207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine