Provider Demographics
NPI:1962473678
Name:SIDHU, BALWINDER SINGH (MD)
Entity Type:Individual
Prefix:DR
First Name:BALWINDER
Middle Name:SINGH
Last Name:SIDHU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3200 FAIRHILL DRIVE
Mailing Address - Street 2:STE. 106
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-3219
Mailing Address - Country:US
Mailing Address - Phone:919-781-6655
Mailing Address - Fax:919-781-0306
Practice Address - Street 1:3200 FAIRHILL DRIVE
Practice Address - Street 2:STE. 106
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-3219
Practice Address - Country:US
Practice Address - Phone:919-781-6655
Practice Address - Fax:919-781-0306
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC9300591207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8976117Medicaid