Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 152210 | MA |
NPI | 1164416186 |
---|---|
Provider Name | Aqeel M Siddiqui |
First Address | Brockton, MA 02301-1191 |
Second Address | Brockton, MA 02301-1191 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2005 |
Last Update Date | 26/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G67198 | (02) |