Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0002X | Hospice and Palliative Medicine | 0101245312 | VA |
NPI | 1093953168 |
---|---|
Provider Name | Dr. Muhammad Mannan Siddiqui |
First Address | Fairfax, VA 22031-4618 |
Second Address | Fairfax, VA 22031-4628 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2009 |
Last Update Date | 11/07/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1093953168 | (05) | VA |