1457709354 NPI number — DR. ADNAN MUDDASSIR SIDDIQUI M.D.

Table of content: DR. ADNAN MUDDASSIR SIDDIQUI M.D. (NPI 1457709354)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457709354 NPI number — DR. ADNAN MUDDASSIR SIDDIQUI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIDDIQUI
Provider First Name:
ADNAN
Provider Middle Name:
MUDDASSIR
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457709354
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/01/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1155 MILL GARDEN CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREAT FALLS
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22066-1845
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-786-9141
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20680 SENECA MEADOWS PKWY STE 206
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GERMANTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20876-7029
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-399-8027
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/01/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208100000X , with the licence number: D0090853 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)