Provider Demographics
NPI:1639305444
Name:VIDWAN, SIMARPREET KAUR (MD)
Entity Type:Individual
Prefix:DR
First Name:SIMARPREET
Middle Name:KAUR
Last Name:VIDWAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SIMARPREET
Other - Middle Name:KAUR
Other - Last Name:SIDHU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-384-9960
Mailing Address - Fax:704-384-9965
Practice Address - Street 1:10514 PARK RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-8405
Practice Address - Country:US
Practice Address - Phone:704-384-9960
Practice Address - Fax:704-384-9965
Is Sole Proprietor?:No
Enumeration Date:2009-06-08
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2017-02286207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine