MEDICARE: DR. SURESH M SIDH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	D0023339	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518935949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SURESH M SIDH M.D.

Provider Business Mailing Address
First Line	:	25 CROSSROADS DR
Second Line	:	STE 306
City	:	OWINGS MILLS
State	:	MD
Zip	:	21117-5421
Country	:	US
Telephone Number	:	410-876-1072
Fax Number	:	410-871-1074

Provider Business Practice Location Address
First Line	:	826 WASHINGTON RD
Second Line	:	STE 215
City	:	WESTMINSTER
State	:	MD
Zip	:	21157-5750
Country	:	US
Telephone Number	:	410-876-1633
Fax Number	:	410-840-2100

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	10/19/2011

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