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General NPI Number Information
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NPI Number | 1609549195
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Entity Type | Individual
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Provider Name | TANVEER SINGH SIDHU MD
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Gender | Male
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Dates
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Enumeration Date | 07/29/2021
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Last Update Date | 01/10/2025
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Provider Practice Location Address
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Address Line | 159 MARGARET ST STE 100
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City | PLATTSBURGH
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State | NY
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Zip | 12901-1874
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Country | US
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Telephone | 518-314-3939
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Fax |
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Provider Business Mailing Address
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Address Line | 1701 N 13TH ST
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City | SHELTON
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State | WA
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Zip | 98584-2077
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Country | US
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Telephone | 603-426-2653
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Fax | 888-985-0681
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD61503842
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License Number State | WA
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