Provider Demographics
NPI:1447285705
Name:SIDOU, VICKIE (MD ANESTHESIOLOGIST)
Entity type:Individual
Prefix:DR
First Name:VICKIE
Middle Name:
Last Name:SIDOU
Suffix:
Gender:F
Credentials:MD ANESTHESIOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:489 STATE ST
Mailing Address - Street 2:PO BOX 404 EMMC
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-6616
Mailing Address - Country:US
Mailing Address - Phone:207-973-5918
Mailing Address - Fax:207-973-4371
Practice Address - Street 1:489 STATE ST
Practice Address - Street 2:EMMC ANESTHESIA DEPT
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6616
Practice Address - Country:US
Practice Address - Phone:207-973-5918
Practice Address - Fax:207-973-4371
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME010720207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B86281Medicare UPIN
015460Medicare ID - Type Unspecified