Healthcare Provider Details

I. General information

NPI: 1093959090
Provider Name (Legal Business Name): JASWINDER SIDHU LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2009
Last Update Date: 04/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 RESEARCH BLVD SUITE#350
ROCKVILLE MD
20850-3215
US

IV. Provider business mailing address

10500 BIT AND SPUR LN
POTOMAC MD
20854-1507
US

V. Phone/Fax

Practice location:
  • Phone: 301-983-2529
  • Fax:
Mailing address:
  • Phone: 301-983-2529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberD0013987
License Number StateMD

VIII. Authorized Official

Name: DR. JASWINDER SIDHU
Title or Position: PRESIDENT
Credential: M.D.
Phone: 301-983-2529