Healthcare Provider Details

I. General information

NPI: 1437611886
Provider Name (Legal Business Name): WARDAH SIDDIQ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2019
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 GENESEE ST
ROCHESTER NY
14611-3201
US

IV. Provider business mailing address

100 KINGS HWY S
ROCHESTER NY
14617-5504
US

V. Phone/Fax

Practice location:
  • Phone: 585-368-3031
  • Fax: 585-368-3037
Mailing address:
  • Phone: 585-922-5462
  • Fax: 585-922-1011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number317710
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: