Individual
CHARLES LEEMAN DENNIS SIFTON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1405 KILN CREEK PKWY, NEWPORT NEWS, VA 23602-9700
(757) 872-7200
(757) 872-8850
Mailing address
101 ABIGAIL LN, WILLIAMSBURG, VA 23185-6506
(757) 565-3962
(757) 565-9649
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101057273
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0100065402
MEDICAID KILN CREEK OFFIC
—
01
—
136888
ANTHEM - HIDENWOOD OFFICE
—
01
—
136927
ANTHEM - KILN CREEK OFFIC
—
Enumeration date
10/31/2005
Last updated
07/08/2007
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