Provider Demographics
NPI:1104817188
Name:SIFTON, CHARLES LEEMAN DENNIS (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:LEEMAN DENNIS
Last Name:SIFTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 ABIGAIL LN
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-6506
Mailing Address - Country:US
Mailing Address - Phone:757-565-3962
Mailing Address - Fax:757-565-9649
Practice Address - Street 1:1405 KILN CREEK PKWY
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-9700
Practice Address - Country:US
Practice Address - Phone:757-872-7200
Practice Address - Fax:757-872-8850
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101057273207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
136927OtherANTHEM - KILN CREEK OFFIC
136888OtherANTHEM - HIDENWOOD OFFICE
0100065402OtherMEDICAID KILN CREEK OFFIC
136927OtherANTHEM - KILN CREEK OFFIC
003741J76Medicare ID - Type Unspecified