Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 0101250699 | VA |
N | 207K00000X | Allergist & Immunologist | D0062974 | MD |
NPI | 1093750796 |
---|---|
Provider Name | Shaz Siddiqi |
First Address | Lansdowne, VA 20176-3459 |
Second Address | Lansdowne, VA 20176-3459 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2006 |
Last Update Date | 17/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
020282ZRGM | MEDICARE PTAN (01) | DC |
H42724 | (02) | MD |