Provider Demographics
NPI:1518935949
Name:SIDH, SURESH M (MD)
Entity Type:Individual
Prefix:DR
First Name:SURESH
Middle Name:M
Last Name:SIDH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:25 CROSSROADS DR
Mailing Address - Street 2:STE 306
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5421
Mailing Address - Country:US
Mailing Address - Phone:410-876-1072
Mailing Address - Fax:410-871-1074
Practice Address - Street 1:826 WASHINGTON RD
Practice Address - Street 2:STE 215
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5750
Practice Address - Country:US
Practice Address - Phone:410-876-1633
Practice Address - Fax:410-840-2100
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2011-10-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0023339208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD260501500Medicaid
MDC57881Medicare UPIN
MD699BMedicare ID - Type UnspecifiedINDIVIDUAL ID
MD260501500Medicaid