Provider Demographics
NPI:1528023967
Name:SIDHU, SURINDERPAL (MD)
Entity Type:Individual
Prefix:MRS
First Name:SURINDERPAL
Middle Name:
Last Name:SIDHU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 WEST ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-3905
Mailing Address - Country:US
Mailing Address - Phone:508-473-2022
Mailing Address - Fax:508-478-7395
Practice Address - Street 1:211 WEST ST
Practice Address - Street 2:SUITE 1
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-3905
Practice Address - Country:US
Practice Address - Phone:508-473-2022
Practice Address - Fax:508-478-7395
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI9134207R00000X
MA56299207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI8025262Medicaid
RI0000203829OtherBLUE CHIP
RI0000022375OtherBC BS RI
RI0000022375OtherBC BS RI
RI8025262Medicaid