Brentwood Clinic, P.a.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

96-00733 Issued in NC

Legal business name

BRENTWOOD CLINIC, P.A.

Practice address

110 Brentwood Center LN N
Wilson, NC 27896-1710

Phone

(252) 291-8600

Fax

(252) 291-6914

NPI assigned

Oct 1, 2008

Last updated

Oct 6, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Medhat Fahmy Sidaros, M.D.NPI 1275508830

Title

Owner/President

Phone

(252) 291-8600

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Medhat Fahmey Sidaros, MD

  • Internal Medicine Physician
  • Wilson, NC
  • NPI 1275508830
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1222819200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1223251200000",
    "number": "1497906051",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3544",
            "city": "WILSON",
            "state": "NC",
            "postal_code": "278953544",
            "telephone_number": "252-291-8600",
            "fax_number": "252-291-6914"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 BRENTWOOD CENTER LN N",
            "city": "WILSON",
            "state": "NC",
            "postal_code": "278961710",
            "telephone_number": "252-291-8600",
            "fax_number": "252-291-6914"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRENTWOOD CLINIC, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-01",
        "last_updated": "2008-10-06",
        "status": "A",
        "authorized_official_last_name": "SIDAROS",
        "authorized_official_first_name": "MEDHAT",
        "authorized_official_middle_name": "FAHMY",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "252-291-8600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "96-00733",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5900812",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Deborah Bryant Boye
• Sarah Bradley
• April N Brantley, LPCA
• Julian C Brantley III, MD
• Rebecca Allen Brantley, PHARM D.
• Douglas C Brewer, MD
• Jo Ann Brewer, RN,FNP
• Stacy Brewer, LMBT
• Edward Sharp Brezina Jr., M.D.
• Bridges of Hope Inc

• Internal Medicine Physician in Wilson, NC
• Providers in Wilson, NC by specialty
• Internal Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 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.

Verify at the official NPI Registry.