Organization
BRENTWOOD CLINIC, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MEDHAT FAHMY SIDAROS M.D. (OWNER/PRESIDENT)
(252) 291-8600
Entity
Organization
Contact information
Practice address
110 BRENTWOOD CENTER LN N, WILSON, NC 27896-1710
(252) 291-8600
(252) 291-6914
Mailing address
PO BOX 3544, WILSON, NC 27895-3544
(252) 291-8600
(252) 291-6914
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
96-00733
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5900812
—
NC
Enumeration date
10/01/2008
Last updated
10/06/2008
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