Provider Demographics
NPI:1841389343
Name:CLEVELAND MEDICAL ASSOCIATES, PA DBA PIEDMONT FAMILY CARE
Entity Type:Organization
Organization Name:CLEVELAND MEDICAL ASSOCIATES, PA DBA PIEDMONT FAMILY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SURENDRA
Authorized Official - Middle Name:PAL
Authorized Official - Last Name:SIDHU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-480-0685
Mailing Address - Street 1:114 LEE ST
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-3839
Mailing Address - Country:US
Mailing Address - Phone:704-480-0685
Mailing Address - Fax:704-480-7356
Practice Address - Street 1:114 LEE ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-3839
Practice Address - Country:US
Practice Address - Phone:704-480-0685
Practice Address - Fax:704-480-7356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC94-01034207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890172TMedicaid
NC2202109BMedicare ID - Type Unspecified
NCE94345Medicare UPIN