Provider Demographics
NPI:1609875434
Name:SIDHU, BALBIR (MD)
Entity Type:Individual
Prefix:DR
First Name:BALBIR
Middle Name:
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 1:8100 ASHTON AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-5622
Mailing Address - Country:US
Mailing Address - Phone:703-331-0300
Mailing Address - Fax:703-331-0254
Practice Address - Street 1:8100 ASHTON AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-5622
Practice Address - Country:US
Practice Address - Phone:703-331-0300
Practice Address - Fax:703-331-0254
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101047068207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5810507Medicaid
DCG00773OtherMEDICARE OF DC PTAN
VAC06380OtherMEDICARE OF VA PTAN
VAF82504Medicare UPIN