Healthcare Provider Details

I. General information

NPI: 1740268010
Provider Name (Legal Business Name): MASOOD A SIDDIQUI MD, FCCP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 01/20/2023
Certification Date: 01/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5509 KIRKWOOD HWY STE 6
WILMINGTON DE
19808-5001
US

IV. Provider business mailing address

5509 KIRKWOOD HWY STE 6
WILMINGTON DE
19808-5001
US

V. Phone/Fax

Practice location:
  • Phone: 302-994-4010
  • Fax: 302-318-9122
Mailing address:
  • Phone: 302-994-4010
  • Fax: 302-318-9122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA06434800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberC1-0007240
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberC1-0007240
License Number StateDE
# 4
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberC1-0007240
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: