BRENTWOOD CLINIC, P.A. (NPI# 1497906051) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497906051 |
| Entity Type | Organization |
| Organization Name | BRENTWOOD CLINIC, P.A. |
| Practice Address |
110 Brentwood Center Ln N Wilson NC 27896-1710 |
| Mailing Address |
Po Box 3544 Wilson NC 27895-3544 |
| Practice Telephone | 2522918600 |
| Practice Fax Number | 2522916914 |
| Mailing Telephone | 2522918600 |
| Mailing Fax Number | 2522916914 |
| Enumeration Date | 2008-10-01 |
| Last Update Date | 2008-10-06 |
| Authorized Official Name | DR. MEDHAT FAHMY SIDAROS (OWNER/PRESIDENT) |
| Authorized Official Telephone | 2522918600 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | 96-00733 | NC | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 5900812 | 05 |
| Street Address |
110 BRENTWOOD CENTER LN N |
| City | WILSON |
| State | NC |
| Zip Code | 27896-1710 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154375202 | Wilson Sleep Disorders Center, Pa | Internal Medicine | 110 Brentwood Center Ln N, Wilson, NC 27896-1710 | 2006-05-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528543972 | Realo Discount Drug Stores of Eastern North Carolina, Inc | Durable Medical Equipment & Medical Supplies | 3724 Raleigh Road Parkway, Suite A, Wilson, NC 27896 | 2018-10-02 |
| 1518450865 | Alysann Brooke Price | Social Worker | 5878 Farmwood Loop, Wilson, NC 27896 | 2018-06-12 |
| 1144744517 | Sara Lynn Campbell | Physical Therapist | 3200 Nash Street North, Wilson, NC 27896 | 2017-07-27 |
| 1902327109 | Lamont Zebediah Barnett | Counselor | 3904 Airport Drive, Wilson, NC 27896 | 2017-06-28 |
| 1578014718 | Kristy Kaye Rowland | Counselor | 3707 Marion Court N, Wilson, NC 27896 | 2016-10-24 |
| 1780058057 | Marsha Ricketts Harper | Occupational Therapy Assistant | 3105 Senior Village Lane, Wilson, NC 27896 | 2015-11-24 |
| 1508122615 | Charlotte Hurt | Social Worker | 910 Raleigh Rd Parkway, Wilson, NC 27896 | 2012-04-03 |
| 1447542139 | Sarah Elizabeth Kirby Bischoff | Pharmacist | 3401 Raleigh Rd, Harris Teeter, Wilson, NC 27896 | 2011-05-12 |
| 1235462342 | Wilson Medical Group | Non-Pharmacy Dispensing Site | 3302 Nash St North, Wilson, NC 27896 | 2009-09-09 |
| 1164662466 | My Friend's House, LLC | Community Based Residential Treatment Facility, Mental Illness | 3607 Columbia Avenue, Wilson, NC 27896 | 2009-02-26 |
| Find all providers in zip 27896 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356682579 | John Louis Gentri | Internal Medicine | Long Leaf Neuro Medical Treatment Center, 4767 Ward Boulevard, Wilson, NC 27893 | 2013-03-13 |
| 1982860367 | David Kiragu | Internal Medicine | 3202 Nash Street N, Wilson, NC 27896-1232 | 2008-08-05 |
| 1457529703 | Jonathon G. Dewald, Md Pa | Internal Medicine | 2605 Forest Hills Rd Sw Ste B, Wilson, NC 27893-4448 | 2008-02-20 |
| 1386862688 | Wilson Internal Medicine Pa | Internal Medicine | 2402 Camden St Sw Ste B500, Wilson, NC 27893-8608 | 2007-04-23 |
| 1467566117 | Mark P Menolascino | Internal Medicine | 5235 Hhr Ranch Road, Wilson, WY 83014-0000 | 2006-08-19 |
| 1447364245 | Michael James Menolascino | Internal Medicine | 5245 Hhr Ranch Road, Wilson, WY 83014-9210 | 2006-08-18 |
| 1720033574 | Lindsey Elliot Deguehery | Internal Medicine | 1812 Glendale Dr Sw, Suite A, Wilson, NC 27893-4402 | 2006-05-23 |
| 1437116613 | Douglas C Brewer | Internal Medicine | 1704 Glendale Dr Sw, Suite B, Wilson, NC 27893-4415 | 2006-04-30 |
| 1598726812 | Thomas E Hooper | Internal Medicine | 2130 Forest Hills Rd W, Ste B, Wilson, NC 27893-3681 | 2006-03-28 |
| 1275508830 | Medhat F Sidaros | Internal Medicine | 2402 Camden St Sw, Suite B 500, Wilson, NC 27893-8608 | 2006-02-17 |
| Find all providers in WILSON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.