Healthcare Provider Details

I. General information

NPI: 1770666570
Provider Name (Legal Business Name): DILBAGH SINGH SIDHU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 08/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7839 ROLLING ROAD
SPRINGFIELD VA
22153-2821
US

IV. Provider business mailing address

7839 ROLLING ROAD SUITE A
SPRINGFIELD VA
22153-2821
US

V. Phone/Fax

Practice location:
  • Phone: 703-569-6998
  • Fax: 703-569-7008
Mailing address:
  • Phone: 703-569-6998
  • Fax: 703-569-7008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101033011
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101033011
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: