Healthcare Provider Details

I. General information

NPI: 1740426774
Provider Name (Legal Business Name): MUHAMMAD KAMRAN SIDDIQUE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2008
Last Update Date: 04/05/2024
Certification Date: 04/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2977 FOUR H PARK RD STE 102
CENTREVILLE MD
21617-2237
US

IV. Provider business mailing address

PO BOX 749495
ATLANTA GA
30374-9495
US

V. Phone/Fax

Practice location:
  • Phone: 410-758-4030
  • Fax: 107-584-7334
Mailing address:
  • Phone: 239-432-8331
  • Fax: 813-321-1296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number40042
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberD0076690
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: