MEDICARE: DR. MAHMOOD SIDDIQUE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	MD055412L	PA
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	MD055412L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235114059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAHMOOD SIDDIQUE M.D.

Provider Business Mailing Address
First Line	:	1271 TRESSLER DR
Second Line	:
City	:	FORT WASHINGTON
State	:	PA
Zip	:	19034-1729
Country	:	US
Telephone Number	:	215-728-3714
Fax Number	:	215-728-3923

Provider Business Practice Location Address
First Line	:	7600 CENTRAL AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19111-2442
Country	:	US
Telephone Number	:	215-728-3714
Fax Number	:	215-728-3923

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	02/09/2016

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