Individual provider Active NPI

Siddharth Dalal, MD

  • Neurology Physician
  • Charlotte, NC
National Provider Identifier
1811488455
Registry record updated Aug 28, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
2024-01310 Issued in NC
Practice address
200 Hawthorne LN
Charlotte, NC 28204-2515
Phone
(704) 384-9437
NPI assigned
May 18, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2026

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

Specialties & licenses 12

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 101754 GA
Neurology Physician 2084N0400X 0101282560 VA
Neurology Physician 2084N0400X 2024032609 MO
Neurology Physician 2084N0400X 341425 LA
Neurology Physician 2084N0400X 2024-01310 NC Primary
Neurology Physician 2084N0400X ME169008 FL
Neurology Physician 2084N0400X MD61554733 WA
Neurology Physician 2084N0400X 036.171540 IL
Neurology Physician 2084N0400X 84723-20 WI
Neurology Physician 2084N0400X 71288 TN
Neurology Physician 2084N0400X 326381 NY
Neurology Physician 2084N0400X MD220760 OR

Addresses

Primary practice location

200 Hawthorne LN
Charlotte, NC 28204-2515

Mailing address

PO Box 60447
Charlotte, NC 28260-0447

Other practice location 1

2801 N Gantenbein Ave
Portland, OR 97227-1623
Phone (503) 413-2200

Other practice location 2

2211 NE 139th St
Vancouver, WA 98686-2742
Phone (360) 487-1000

Other practice location 3

1420 Tusculum Blvd
Greeneville, TN 37745-4279
Phone (423) 787-5000

Other practice location 4

300 Community Dr
Manhasset, NY 11030-3816
Phone (516) 325-7000

Other practice location 5

2000 Brookside Dr
Kingsport, TN 37660-4627
Phone (423) 857-7000

Other practice location 6

130 W Ravine Rd
Kingsport, TN 37660-3837
Phone (423) 224-3150

Other practice location 7

1990 Holton Ave E
Big Stone Gap, VA 24219-3350
Phone (276) 523-3111

Other practice location 8

300 Med Tech Pkwy
Johnson City, TN 37604-2277
Phone (423) 302-1000

Other practice location 9

100 15th St NW
Norton, VA 24273-1616
Phone (423) 630-7001

Other practice location 10

1102 W 32nd St
Joplin, MO 64804-3503
Phone (417) 347-4570

Other practice location 11

1000 Johnson Ferry Rd
Atlanta, GA 30342-1606
Phone (404) 851-8000

Other practice location 12

3000 New Bern Ave
Raleigh, NC 27610-1231
Phone (919) 350-8000

Other practice location 13

127 Health Care Dr
Pennington Gap, VA 24277-2853
Phone (276) 299-5000

Other practice location 14

12200 Warwick Blvd Ste 110
Newport News, VA 23601-2344
Phone (757) 534-5100

Other practice location 15

1 Medical Park Blvd
Bristol, TN 37620-7430
Phone (423) 844-1121

Other practice location 16

400 N State Of Franklin Rd
Johnson City, TN 37604-6035
Phone (423) 431-6111

Other practice location 17

851 Locust St
Rogersville, TN 37857-2407
Phone (423) 921-7000

Other practice location 18

1501 W Elk Ave
Elizabethton, TN 37643-2874
Phone (423) 542-1300

Other practice location 19

1519 Main St
Sneedville, TN 37869-3657
Phone (423) 733-5000

Other practice location 20

375 N Wall St Ste P510
Kankakee, IL 60901-3492
Phone (815) 935-0750

Other practice location 21

2030 Temple Hill Rd
Erwin, TN 37650-8721
Phone (423) 743-3141

Other practice location 22

1901 S Shady St
Mountain City, TN 37683-2021
Phone (423) 727-1100

Other practice location 23

16000 Johnston Memorial Dr
Abingdon, VA 24211-7664
Phone (276) 258-1000

Other practice location 24

245 Medical Park Dr
Marion, VA 24354-1100
Phone (276) 378-1000

Other practice location 25

58 Carroll Street
Lebanon, VA 24266-4510
Phone (276) 883-8000

Other practice location 26

312 Hospital Dr
Clintwood, VA 24228-6786
Phone (276) 926-0300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, VA, NC, TN, MO, WA, GA, MS, ME, OR, IL, WI12 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 12

Enrollment IDStateProvider typePAC IDDetails
I20240429000558 NY Practitioner - Neurology 4789928730 Reassigns benefits to 6 organizations
I20240805004201 VA Practitioner - Neurology 4789928730 Reassigns benefits to 2 organizations
I20240919001809 NC Practitioner - Neurology 4789928730 Reassigns benefits to 2 organizations
I20241125000381 TN Practitioner - Neurology 4789928730 Reassigns benefits to 1 organization
I20250115003480 MO Practitioner - Neurology 4789928730 Reassigns benefits to 2 organizations
I20250415003403 WA Practitioner - Neurology 4789928730 Reassigns benefits to 2 organizations
I20250519000770 GA Practitioner - Neurology 4789928730 Reassigns benefits to 2 organizations
I20250715004204 MS Practitioner - Neurology 4789928730 Reassigns benefits to 1 organization
I20250808000306 ME Practitioner - Neurology 4789928730 Reassigns benefits to 5 organizations
I20250910002608 OR Practitioner - Neurology 4789928730 Reassigns benefits to 2 organizations
I20260127002075 IL Practitioner - Neurology 4789928730 Reassigns benefits to 1 organization
I20260129002483 WI Practitioner - Neurology 4789928730 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
North Atlanta Professional Services LLCGroup PAC ID 0840291944, 423 clinicians
North Shore-Lij Medical PCGroup PAC ID 3375701568, 6,374 clinicians
Adventist Health System Georgia IncGroup PAC ID 4486568037, 247 clinicians
Freeman-Oak Hill Health SystemGroup PAC ID 8325942253, 385 clinicians
Riverside Physician Services IncGroup PAC ID 5092608448, 793 clinicians
Wellmont Medical Associates IncGroup PAC ID 8123291739, 432 clinicians
North Oaks Medical Center LLCGroup PAC ID 2466629522, 317 clinicians
WakemedGroup PAC ID 7315937612, 72 clinicians
Singing River Health SystemGroup PAC ID 3870405194, 290 clinicians
Manhattan Medical Arts PLLCGroup PAC ID 9638418387, 3 clinicians

Practice addresses (Care Compare)

1000 Johnson Ferry Rd NE
Atlanta, GA 30342-1606
Phone (404) 851-8000

10201 66TH Rd
Forest Hills, NY 11375-2029
Phone (718) 830-4000

1035 Red Bud Rd NE
Suite 101
Calhoun, GA 30701-6011
Phone (706) 625-4285

1102 W 32 St
Joplin, MO 64804-3503

12200 Warwick Blvd
Suite 110
Newport News, VA 23601-2344
Phone (757) 534-5100

130 W Ravine Rd
Kingsport, TN 37660-3837
Phone (423) 230-8412

16000 Johnson Memorial Dr
Abingdon, VA 24211-7664
Phone (276) 258-8200

189 Schermerhorn St
Apt 21C
Brooklyn, NY 11201-6614
Phone (478) 284-3074

3000 New Bern Ave
Raleigh, NC 27610-1231
Phone (919) 350-8000

3603 Bienville Blvd
Ocean Springs, MS 39564-5727
Phone (228) 818-9620

492 6TH Ave
New York, NY 10011-8404
Phone (646) 454-9000

Hospital & facility affiliations

  • Staten Island University Hospital Hospital, Staten Island, NY, CCN 330160
  • North Shore University Hospital Hospital, Manhasset, NY, CCN 330106
  • Freeman Health System - Freeman West Hospital, Joplin, MO, CCN 260137
  • Peconic Bay Medical Center Hospital, Riverhead, NY, CCN 330107
  • Northside Hospital Gwinnett Hospital, Lawrenceville, GA, CCN 110087

Merit-based Incentive Payment System (MIPS)

Final score
86.91 of 100Reported as group
Quality
78.17
Promoting interoperability
100
Improvement activities
40
Cost
67.71

Merit-based Incentive Payment System (MIPS)

Final score
93.07 of 100Reported as apm
Quality
79.77
Promoting interoperability
88.77
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
94.91 of 100Reported as apm
Quality
92.86
Promoting interoperability
94.93
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
326381NYMDLicensed Practical Nurse
ME169008FLMDNeurology Physician
036.171540ILMDNeurology Physician
341425LAMDNeurology Physician
2024032609MOMDNeurology Physician
2024-01310NCMDNeurology Physician
71288TNMDNeurology Physician

Practice roles (53 of 57)

OrganizationSpecialtyStatusNew patients
Centra Medical Group, LLC CurrentSince Oct 16, 2024 Accepting new patients
Wellmont Medical Associates, Inc. CurrentSince Oct 1, 2024 Accepting new patients
Riverside Health System CurrentSince Dec 16, 2025 Accepting new patients
Bridgton Hospital CurrentSince Jul 9, 2025 Accepting new patients
Riverside Physician Services, Inc. Internal Medicine CurrentSince Jun 18, 2024 Accepting new patients
Wellmont Medical Associates Inc CurrentSince Oct 1, 2024 Accepting new patients
Wellmont Medical Associates Inc Internal Medicine Current Accepting new patients
Singing River Health System CurrentSince May 8, 2025 Accepting new patients
Silverton Health CurrentSince Aug 26, 2025 Accepting new patients
Wyoming County Current Accepting new patients
Rumford Hospital CurrentSince Jul 9, 2025 Accepting new patients
Legacy Salmon Creek Hospital CurrentSince Aug 26, 2025 Accepting new patients
Wakemed Internal Medicine CurrentSince Dec 4, 2024 Accepting new patients
North Oaks Medical Center, LLC Current Accepting new patients
Riverside Physician Services Inc Current Accepting new patients
Wellmont Medical Associates, Inc. Internal Medicine CurrentSince Oct 1, 2024 Accepting new patients
Central Maine Medical Center CurrentSince Jul 9, 2025 Accepting new patients
Vidant Medical Group LLC CurrentSince Jan 1, 2026 Accepting new patients
Manhattan Medical Arts, PLLC CurrentSince Apr 27, 2024 Accepting new patients
Novant Health Medical Group, LLC Current Accepting new patients
Riverside Health System CurrentSince Dec 16, 2025 Accepting new patients
Freeman-Oak Hill Health System Internal Medicine CurrentSince Dec 19, 2024 Accepting new patients
Bridgton Hospital CurrentSince Jul 9, 2025 Accepting new patients
Agnesian Healthcare, Inc CurrentSince Mar 1, 2026 Accepting new patients
Wyoming County Internal Medicine CurrentSince Mar 7, 2025 Accepting new patients
Legacy Salmon Creek Hospital CurrentSince Aug 26, 2025 Accepting new patients
North Oaks Medical Center, LLC CurrentSince Jun 12, 2024 Accepting new patients
Legacy Clinics LLC CurrentSince Aug 26, 2025 Accepting new patients
Silverton Health CurrentSince Aug 26, 2025 Accepting new patients
Riverside Physician Services Inc CurrentSince Jun 18, 2024 Accepting new patients
North Shore-Lij Medical PC Internal Medicine CurrentSince Mar 6, 2024 Accepting new patients
North Shore - Lij Medical PC Internal Medicine CurrentSince Mar 6, 2024 Accepting new patients
The Monroe Clinic, Inc. CurrentSince Jan 1, 2026 Accepting new patients
The Monroe Clinic, Inc. CurrentSince Jan 1, 2026 Accepting new patients
Novant Health Medical Group, LLC CurrentSince Aug 1, 2024 Accepting new patients
Silverton Health Current Accepting new patients
Multicare Health System CurrentSince Mar 1, 2025 Accepting new patients
Wyoming County Current Accepting new patients
Adventist Health System Georgia Inc CurrentSince May 1, 2025 Accepting new patients
Rumford Hospital CurrentSince Jul 9, 2025 Accepting new patients
Multicare Health System CurrentSince Mar 1, 2025 Accepting new patients
Legacy Clinics LLC Internal Medicine CurrentSince Aug 26, 2025 Accepting new patients
Agnesian Healthcare Inc CurrentSince Mar 1, 2026 Accepting new patients
Multicare Health System Current Accepting new patients
Novant Health Medical Group, LLC Neurology CurrentSince Aug 1, 2024 Accepting new patients
North Atlanta Professional Services LLC CurrentSince Jul 8, 2025 Accepting new patients
Central Maine Medical Center CurrentSince Jul 9, 2025 Accepting new patients
Freeman-Oak Hill Health System CurrentSince Dec 19, 2024 Accepting new patients
Wakemed CurrentSince Dec 4, 2024 Accepting new patients
Wyoming County CurrentSince Mar 7, 2025 Accepting new patients
Montefiore New Rochelle Hospital PastSince Apr 27, 2024 Accepting new patients
Staten Island University Hospital Past Accepting new patients
Adventist Health System Georgia, Inc. PastSince May 1, 2025 Accepting new patients

Locations (25 of 61)

1035 Red Bud Rd NE
Calhoun, GA 30701
Phone (706) 602-7800

1035 Red Bud Rd NE
Ste 101
Calhoun, GA 30701
Phone (706) 625-4285

707 Old Dalton Ellijay Rd
Chatsworth, GA 30705
Phone (706) 517-2050

1000 Johnson Fy Rd NE
Sandy Springs, GA 30342
Phone (404) 851-1000

1000 Johnson Ferry Rd
Sandy Springs, GA 30342
Phone (404) 851-8737

375 N Wall St
Ste P510
Kankakee, IL 60901
Phone (815) 935-0750

105 S First St
Wilmington, IL 60481
Phone (815) 476-5210

15790 Paul Vega Md Dr
Hammond, LA 70403
Phone (985) 230-1682

10 Hospital Dr
Bridgton, ME 04009
Phone (207) 647-6000

300 Main St
Lewiston, ME 04240
Phone (207) 795-2400

420 Franklin St
Rumford, ME 04276
Phone (207) 364-4581

1102 W 32nd St
Joplin, MO 64804
Phone (417) 347-1078

307 W 11th St
Lamar, MO 64759
Phone (417) 682-3300

2101 Highway 90
Gautier, MS 39553
Phone (228) 497-7576

3603 Bienville Blvd
Ocean Springs, MS 39564
Phone (228) 762-3000

1900 Kildaire Farm Rd
Cary, NC 27518
Phone (919) 350-2300

1918 Randolph Rd
Ste 400
Charlotte, NC 28207
Phone (704) 384-9437

200 Hawthorne Ln
Charlotte, NC 28204
Phone (704) 377-2424

3000 New Bern Ave
Raleigh, NC 27610
Phone (919) 350-7000

5145 Sellers Rd
Shallotte, NC 28470
Phone (910) 754-4441

190 Kimel Park Dr
Ste 120
Winston Salem, NC 27103
Phone (336) 277-2200

2825 Lyndhurst Ave
Ste 101
Winston Salem, NC 27103
Phone (336) 277-6300

10201 66th Rd
Forest Hills, NY 11375
Phone (718) 830-4091

7214 Austin St
Forest Hills, NY 11375
Phone (646) 454-9000

492 6th Ave
New York, NY 10011
Phone (646) 454-9000

Networks

  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H9678

Interoperability endpoints

  • Direct secure messaging: sdalal1602803@direct.novanthealth.org
  • FHIR API: https://fhir-myrecord.cerner.com/r4/4517c430-03bf-4e32-b324-1387cc4e73f3/
  • Direct secure messaging: sdalal66984@northwell.direct-ci.com

Organizations & group practices 85

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

View all 85

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1526601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787875200000",
    "number": "1811488455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 HAWTHORNE LN",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282042515",
            "telephone_number": "704-384-9437"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2801 N Gantenbein Ave",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972271623",
            "country_code": "US",
            "telephone_number": "503-413-2200",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2211 NE 139th St",
            "address_purpose": "LOCATION",
            "city": "Vancouver",
            "state": "WA",
            "postal_code": "986862742",
            "country_code": "US",
            "telephone_number": "360-487-1000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1420 Tusculum Blvd",
            "address_purpose": "LOCATION",
            "city": "Greeneville",
            "state": "TN",
            "postal_code": "377454279",
            "country_code": "US",
            "telephone_number": "423-787-5000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "300 Community Dr",
            "address_purpose": "LOCATION",
            "city": "Manhasset",
            "state": "NY",
            "postal_code": "110303816",
            "country_code": "US",
            "telephone_number": "516-325-7000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2000 Brookside Dr",
            "address_purpose": "LOCATION",
            "city": "Kingsport",
            "state": "TN",
            "postal_code": "376604627",
            "country_code": "US",
            "telephone_number": "423-857-7000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "130 W Ravine Rd",
            "address_purpose": "LOCATION",
            "city": "Kingsport",
            "state": "TN",
            "postal_code": "376603837",
            "country_code": "US",
            "telephone_number": "423-224-3150",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1990 Holton Ave E",
            "address_purpose": "LOCATION",
            "city": "Big Stone Gap",
            "state": "VA",
            "postal_code": "242193350",
            "country_code": "US",
            "telephone_number": "276-523-3111",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "300 Med Tech Pkwy",
            "address_purpose": "LOCATION",
            "city": "Johnson City",
            "state": "TN",
            "postal_code": "376042277",
            "country_code": "US",
            "telephone_number": "423-302-1000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "100 15th St NW",
            "address_purpose": "LOCATION",
            "city": "Norton",
            "state": "VA",
            "postal_code": "242731616",
            "country_code": "US",
            "telephone_number": "423-630-7001",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1102 W 32nd St",
            "address_purpose": "LOCATION",
            "city": "Joplin",
            "state": "MO",
            "postal_code": "648043503",
            "country_code": "US",
            "telephone_number": "417-347-4570",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1000 Johnson Ferry Rd",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303421606",
            "country_code": "US",
            "telephone_number": "404-851-8000",
            "fax_number": "404-303-3759",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3000 New Bern Ave",
            "address_purpose": "LOCATION",
            "city": "Raleigh",
            "state": "NC",
            "postal_code": "276101231",
            "country_code": "US",
            "telephone_number": "919-350-8000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "127 Health Care Dr",
            "address_purpose": "LOCATION",
            "city": "Pennington Gap",
            "state": "VA",
            "postal_code": "242772853",
            "country_code": "US",
            "telephone_number": "276-299-5000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "12200 Warwick Blvd Ste 110",
            "address_purpose": "LOCATION",
            "city": "Newport News",
            "state": "VA",
            "postal_code": "236012344",
            "country_code": "US",
            "telephone_number": "757-534-5100",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1 Medical Park Blvd",
            "address_purpose": "LOCATION",
            "city": "Bristol",
            "state": "TN",
            "postal_code": "376207430",
            "country_code": "US",
            "telephone_number": "423-844-1121",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "400 N State Of Franklin Rd",
            "address_purpose": "LOCATION",
            "city": "Johnson City",
            "state": "TN",
            "postal_code": "376046035",
            "country_code": "US",
            "telephone_number": "423-431-6111",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "851 Locust St",
            "address_purpose": "LOCATION",
            "city": "Rogersville",
            "state": "TN",
            "postal_code": "378572407",
            "country_code": "US",
            "telephone_number": "423-921-7000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1501 W Elk Ave",
            "address_purpose": "LOCATION",
            "city": "Elizabethton",
            "state": "TN",
            "postal_code": "376432874",
            "country_code": "US",
            "telephone_number": "423-542-1300",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1519 Main St",
            "address_purpose": "LOCATION",
            "city": "Sneedville",
            "state": "TN",
            "postal_code": "378693657",
            "country_code": "US",
            "telephone_number": "423-733-5000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "375 N Wall St Ste P510",
            "address_purpose": "LOCATION",
            "city": "Kankakee",
            "state": "IL",
            "postal_code": "609013492",
            "country_code": "US",
            "telephone_number": "815-935-0750",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2030 Temple Hill Rd",
            "address_purpose": "LOCATION",
            "city": "Erwin",
            "state": "TN",
            "postal_code": "376508721",
            "country_code": "US",
            "telephone_number": "423-743-3141",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1901 S Shady St",
            "address_purpose": "LOCATION",
            "city": "Mountain City",
            "state": "TN",
            "postal_code": "376832021",
            "country_code": "US",
            "telephone_number": "423-727-1100",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "16000 Johnston Memorial Dr",
            "address_purpose": "LOCATION",
            "city": "Abingdon",
            "state": "VA",
            "postal_code": "242117664",
            "country_code": "US",
            "telephone_number": "276-258-1000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "245 Medical Park Dr",
            "address_purpose": "LOCATION",
            "city": "Marion",
            "state": "VA",
            "postal_code": "243541100",
            "country_code": "US",
            "telephone_number": "276-378-1000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "58 Carroll Street",
            "address_purpose": "LOCATION",
            "city": "Lebanon",
            "state": "VA",
            "postal_code": "242664510",
            "country_code": "US",
            "telephone_number": "276-883-8000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "312 Hospital Dr",
            "address_purpose": "LOCATION",
            "city": "Clintwood",
            "state": "VA",
            "postal_code": "242286786",
            "country_code": "US",
            "telephone_number": "276-926-0300",
            "country_name": "United States",
            "address_type": "DOM"
        }
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        "first_name": "SIDDHARTH",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-05-18",
        "last_updated": "2026-08-28",
        "certification_date": "2026-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "GA",
            "license": "101754",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "VA",
            "license": "0101282560",
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        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "MO",
            "license": "2024032609",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "LA",
            "license": "341425",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "NC",
            "license": "2024-01310",
            "primary": true
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "FL",
            "license": "ME169008",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "WA",
            "license": "MD61554733",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "IL",
            "license": "036.171540",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "WI",
            "license": "84723-20",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "TN",
            "license": "71288",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "NY",
            "license": "326381",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "OR",
            "license": "MD220760",
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    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

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