Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 0101257053 | VA |
NPI | 1023303658 |
---|---|
Provider Name | Imran J Siddiqui |
First Address | Mc Lean, VA 22101-2334 |
Second Address | Burlington, MA 01805-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2011 |
Last Update Date | 23/06/2015 |