Healthcare Provider Details

I. General information

NPI: 1801991427
Provider Name (Legal Business Name): HOPEWELL ORTHOPAEDIC CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 07/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 E HUNDRED RD
CHESTER VA
23836-2609
US

IV. Provider business mailing address

2 E HUNDRED RD
CHESTER VA
23836-2609
US

V. Phone/Fax

Practice location:
  • Phone: 804-530-0999
  • Fax: 804-530-0997
Mailing address:
  • Phone: 804-530-0999
  • Fax: 804-530-0997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number0101031126
License Number StateVA

VIII. Authorized Official

Name: DR. BALJIT S SIDHU
Title or Position: OWNER
Credential: MD
Phone: 804-530-0999