Healthcare Provider Details

I. General information

NPI: 1104480268
Provider Name (Legal Business Name): SOHAIB SIDDIQUI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2019
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date: 12/09/2019
Reactivation Date: 12/23/2019

III. Provider practice location address

501 CENTERVILLE RD
WARWICK RI
02886-4347
US

IV. Provider business mailing address

3421 ESCADA DRIVE
MISSISSAUGA ONTARIO
L5M 7Y1
CA

V. Phone/Fax

Practice location:
  • Phone: 401-606-2680
  • Fax:
Mailing address:
  • Phone:
  • 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 State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD18437
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: