Healthcare Provider Details

I. General information

NPI: 1699911297
Provider Name (Legal Business Name): DURDANA AAMIR SIDDIQUI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2009
Last Update Date: 04/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 PACIFIC AVE
ATLANTIC CITY NJ
08401
US

IV. Provider business mailing address

1925 PACIFIC AVE
ATLANTIC CITY NJ
08401
US

V. Phone/Fax

Practice location:
  • Phone: 609-441-8146
  • Fax: 609-441-8002
Mailing address:
  • Phone: 609-441-8146
  • Fax: 609-441-8002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number25MA08504400
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA08504400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: