Provider Demographics
NPI:1265474126
Name:SIDHU, JATINDER K (MD)
Entity type:Individual
Prefix:
First Name:JATINDER
Middle Name:K
Last Name:SIDHU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13225 RIVERS BEND BLVD
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23836-8605
Mailing Address - Country:US
Mailing Address - Phone:804-530-0999
Mailing Address - Fax:804-530-0997
Practice Address - Street 1:13225 RIVERS BEND BLVD
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23836-8605
Practice Address - Country:US
Practice Address - Phone:804-530-0999
Practice Address - Fax:804-530-0997
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101034060208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC08460Medicare PIN
VAC09578Medicare PIN