Healthcare Provider Details

I. General information

NPI: 1912646217
Provider Name (Legal Business Name): TALHA MUSEEB SIDDIQUE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2022
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 FARMINGTON AVE
FARMINGTON CT
06030
US

IV. Provider business mailing address

GENGRAS CLINIC AT ST. FRANCIS HOSPITAL 1000 ASYLUM AVENUE
HARTFORD CT
06105
US

V. Phone/Fax

Practice location:
  • Phone: 860-679-6296
  • Fax:
Mailing address:
  • Phone: 860-714-4532
  • Fax: 860-714-8275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: