Active NPI
Jaan E. Sidorov, M.D.
- Internal Medicine Physician
- Harrisburg, PA
National Provider Identifier
1114985066
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- MD032760E
- Practice address
- 413 Village Way
Harrisburg, PA 17112-8849 - Phone
- (717) 566-6287
- Fax
- (717) 566-6310
- NPI assigned
- May 2, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | MD032760E | PA | Primary |
Addresses
Primary practice location
413 Village Way
Harrisburg, PA 17112-8849
Mailing address
413 Village Way
Harrisburg, PA 17112-8849
Phone (717) 566-6287
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 001007329 | Medicaid | PA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD032760E | PA | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146528000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1202428800000",
"number": "1114985066",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "413 VILLAGE WAY",
"city": "HARRISBURG",
"state": "PA",
"postal_code": "171128849",
"telephone_number": "717-566-6287",
"fax_number": "717-566-6310"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "413 VILLAGE WAY",
"city": "HARRISBURG",
"state": "PA",
"postal_code": "171128849",
"telephone_number": "717-566-6287",
"fax_number": "717-566-6310"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIDOROV",
"first_name": "JAAN",
"middle_name": "E.",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-05-02",
"last_updated": "2008-02-08",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "PA",
"license": "MD032760E",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "001007329",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Harrisburg, PA
- Alyssa Catherine Shughart, LSW
- Jennifer Ann Shumaker, CRNA
- Linda Shumaker, RN
- Makala Shutt
- Meghan N Shuttlesworth, MS
- Alexandria Rae Siebecker, CRNA
- Audra Warren Sieber, O.D.
- Siegelbaum, Gunder & Lacey Gastroenterology
- Carolyn A Sienzant, PA-C
- Sierra Homehealth Care Agency, LLC (Sierra Allied Health & Homecare Agency, LLC)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.