Provider Demographics
NPI:1578503686
Name:SIDHU, DALJEET SINGH (MD)
Entity Type:Individual
Prefix:
First Name:DALJEET
Middle Name:SINGH
Last Name:SIDHU
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 1:208 CRAIN HWY SW
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-3530
Mailing Address - Country:US
Mailing Address - Phone:410-787-8332
Mailing Address - Fax:410-787-8722
Practice Address - Street 1:208 CRAIN HWY SW
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-3530
Practice Address - Country:US
Practice Address - Phone:410-787-8332
Practice Address - Fax:410-787-8722
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0038958207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD092531400Medicaid
MDE64998Medicare UPIN
MD092531400Medicaid