MEDICARE: DR. MAGDY KAMILE SIDHOM M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	0101040856	VA
2	207L00000X	Anesthesiology Physician	ME118562	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477514206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAGDY KAMILE SIDHOM M.D.

Provider Business Mailing Address
First Line	:	355 CRAWFORD ST
Second Line	:	SUITE 808
City	:	PORTSMOUTH
State	:	VA
Zip	:	23704-2816
Country	:	US
Telephone Number	:	757-399-1167
Fax Number	:	757-399-1158

Provider Business Practice Location Address
First Line	:	355 CRAWFORD ST
Second Line	:	SUITE 808
City	:	PORTSMOUTH
State	:	VA
Zip	:	23704-2816
Country	:	US
Telephone Number	:	757-399-1157
Fax Number	:	757-399-1158

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2006
Last Update Date	:	01/11/2021

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