Healthcare Provider Details

I. General information

NPI: 1871736967
Provider Name (Legal Business Name): JUDE F. SIDARI, M.D., PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2009
Last Update Date: 03/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 W CHESTNUT ST
HAZLETON PA
18201-6230
US

IV. Provider business mailing address

235 W CHESTNUT ST
HAZLETON PA
18201-6230
US

V. Phone/Fax

Practice location:
  • Phone: 570-455-3339
  • Fax: 570-455-2939
Mailing address:
  • Phone: 570-455-3339
  • Fax: 570-455-2939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberMD040325L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. JUDE FRANCIS SIDARI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 570-455-3339