Healthcare Provider Details

I. General information

NPI: 1073600540
Provider Name (Legal Business Name): DARREN S SIDNEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 01/27/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9221 UNIVERSITY BLVD SUITE 102
NORTH CHARLESTON SC
29406-9148
US

IV. Provider business mailing address

9221 UNIVERSITY BLVD SUITE 102
NORTH CHARLESTON SC
29406-9148
US

V. Phone/Fax

Practice location:
  • Phone: 843-576-0700
  • Fax: 843-576-0701
Mailing address:
  • Phone: 843-576-0700
  • Fax: 843-576-0701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number30166
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number30166
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number30166
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: