Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | MT201227 | PA |
NPI | 1013262195 |
---|---|
Provider Name | Charles Sides |
First Address | Bethlehem, PA 18018-1195 |
Second Address | Bethlehem, PA 18015-1000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2012 |
Last Update Date | 16/07/2012 |