Provider Demographics
NPI:1316264286
Name:SIDHU-BUONOCORE, SUNITA (MD)
Entity type:Individual
Prefix:
First Name:SUNITA
Middle Name:
Last Name:SIDHU-BUONOCORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUNITA
Other - Middle Name:
Other - Last Name:SIDHU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:79 WAWECUS ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2160
Mailing Address - Country:US
Mailing Address - Phone:860-886-2655
Mailing Address - Fax:860-887-9003
Practice Address - Street 1:79 WAWECUS ST
Practice Address - Street 2:SUITE 101
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2160
Practice Address - Country:US
Practice Address - Phone:860-886-2655
Practice Address - Fax:860-887-9003
Is Sole Proprietor?:No
Enumeration Date:2010-04-30
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT48684207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D400021782OtherMEDICARE PTAN
CTP4244379OtherOXFORD
P01052399OtherMEDICARE RAILROAD
CT9593541OtherAETNA