Healthcare Provider Details

I. General information

NPI: 1881145837
Provider Name (Legal Business Name): AISHA SIDDIQA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2016
Last Update Date: 10/19/2022
Certification Date: 10/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 EASTERN SHORE DR
SALISBURY MD
21804-5934
US

IV. Provider business mailing address

5325 NIGHTSHADE COURT
COLUMBIA MD
21045
US

V. Phone/Fax

Practice location:
  • Phone: 410-205-6387
  • Fax:
Mailing address:
  • Phone: 443-699-8624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMTL003543
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD0092934
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: