Provider Demographics
NPI:1891292355
Name:SIDHU, VIRINDER (MD)
Entity type:Individual
Prefix:DR
First Name:VIRINDER
Middle Name:
Last Name:SIDHU
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 1:302 HUSSON AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-3373
Mailing Address - Country:US
Mailing Address - Phone:207-941-2373
Mailing Address - Fax:814-455-2584
Practice Address - Street 1:302 HUSSON AVE STE 2
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3373
Practice Address - Country:US
Practice Address - Phone:207-941-2373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2024-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD474943207R00000X
390200000X
MEMD27625207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program