Healthcare Provider Details

I. General information

NPI: 1073712725
Provider Name (Legal Business Name): SOHAIB SIDDIQUI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 07/29/2021
Certification Date: 07/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1857 WHITE MOUNTAIN HWY
NORTH CONWAY NH
03860-5158
US

IV. Provider business mailing address

PO BOX 125
CENTER CONWAY NH
03813-0125
US

V. Phone/Fax

Practice location:
  • Phone: 603-387-4523
  • Fax: 603-730-5477
Mailing address:
  • Phone: 603-730-5356
  • Fax: 603-730-5477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD19943
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number13603
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: