Basic Information
Provider Information
NPI: 1245236801
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SINDEN
FirstName: JOHN
MiddleName: R
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2920 HIGHWOODS BLVD
Address2:  
City: RALEIGH
State: NC
PostalCode: 276040010
CountryCode: US
TelephoneNumber: 8774984490
FaxNumber:  
Practice Location
Address1: 3000 NEW BERN AVE
Address2: STE 1200
City: RALEIGH
State: NC
PostalCode: 276101231
CountryCode: US
TelephoneNumber: 9192316132
FaxNumber: 9192316276
Other Information
ProviderEnumerationDate: 06/28/2005
LastUpdateDate: 04/13/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/13/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RI0011X35202NCY Allopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology

ID Information
IDTypeStateIssuerDescription
897646505NC MEDICAID
06003547401 RAILROAD MEDICAREOTHER


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