Individual
DR. VICTOR SIDHOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
606 BLACK RIVER RD, GEORGETOWN, SC 29440-3304
(843) 527-7000
Mailing address
PO BOX 421718, GEORGETOWN, SC 29442-4203
(843) 527-7000
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
31567
SC
207R00000X
Internal Medicine Physician
MD432624
PA
208M00000X
Hospitalist Physician
Primary
31567
SC
208M00000X
Hospitalist Physician
MD432624
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8768
MEDICARE GROUP
SC
01
—
GP4697
MEDICAID GROUP
SC
05
—
GP5247
—
SC
Enumeration date
08/30/2007
Last updated
11/07/2025
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