Healthcare Provider Details

I. General information

NPI: 1144610759
Provider Name (Legal Business Name): HAARIS SIDDIQ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2015
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date: 03/21/2023
Reactivation Date: 03/27/2023

III. Provider practice location address

901 HARRY S TRUMAN DR N STE 4217
LARGO MD
20774-5477
US

IV. Provider business mailing address

901 HARRY S TRUMAN DR N STE 4217
LARGO MD
20774-5477
US

V. Phone/Fax

Practice location:
  • Phone: 240-677-0236
  • Fax:
Mailing address:
  • Phone: 240-677-0236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberD0105813
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: