Provider Demographics
NPI:1700886009
Name:SIDA, WAYNE B (MD)
Entity type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:B
Last Name:SIDA
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:P.O. BOX 3193
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29648
Mailing Address - Country:US
Mailing Address - Phone:864-227-5240
Mailing Address - Fax:864-227-5239
Practice Address - Street 1:917 BYPASS 225 S
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-8025
Practice Address - Country:US
Practice Address - Phone:864-227-5240
Practice Address - Fax:864-227-5239
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC184562084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC184561Medicaid
SC130024564OtherRR MEDICARE
SC184561Medicaid
SCG29638Medicare UPIN