Provider Demographics
NPI:1871736967
Name:JUDE F. SIDARI, M.D., PC
Entity type:Organization
Organization Name:JUDE F. SIDARI, M.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDE
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:SIDARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-455-3339
Mailing Address - Street 1:235 W CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18201-6230
Mailing Address - Country:US
Mailing Address - Phone:570-455-3339
Mailing Address - Fax:570-455-2939
Practice Address - Street 1:235 W CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201-6230
Practice Address - Country:US
Practice Address - Phone:570-455-3339
Practice Address - Fax:570-455-2939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-20
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD040325L261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA149219Medicare PIN