Provider Demographics
NPI:1700825452
Name:SIDARI, JUDE FRANCIS (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDE
Middle Name:FRANCIS
Last Name:SIDARI
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 1:235 W CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18201-6230
Mailing Address - Country:US
Mailing Address - Phone:570-455-3339
Mailing Address - Fax:570-455-2939
Practice Address - Street 1:235 W CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201-6230
Practice Address - Country:US
Practice Address - Phone:570-455-3339
Practice Address - Fax:570-455-2939
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD040325L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012196990002Medicaid
PA149219OtherMEDICARE ID
PA1022921120001Medicaid
147232OtherBS
PA0012196990002Medicaid
PA149219Medicare Oscar/Certification