Healthcare Provider Details

I. General information

NPI: 1972239051
Provider Name (Legal Business Name): VERINDER SINGH SIDHU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2022
Last Update Date: 07/29/2022
Certification Date: 07/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 S 11TH ST
PHILADELPHIA PA
19107-4824
US

IV. Provider business mailing address

2200 BENJAMIN FRANKLIN PKWY APT N1804
PHILADELPHIA PA
19130-3721
US

V. Phone/Fax

Practice location:
  • Phone: 267-297-2440
  • Fax:
Mailing address:
  • Phone: 484-388-3371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License NumberLT000941
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: