Healthcare Provider Details

I. General information

NPI: 1649371493
Provider Name (Legal Business Name): AFREEN SIDDIQUI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 JEFFERSON BLVD SUITE 1002
WARWICK RI
02886-2225
US

IV. Provider business mailing address

1 DARL CT
EAST GREENWICH RI
02818-1129
US

V. Phone/Fax

Practice location:
  • Phone: 401-490-7530
  • Fax: 401-490-7533
Mailing address:
  • Phone: 401-884-7107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number237374
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMD10820
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number237374
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: