Healthcare Provider Details

I. General information

NPI: 1427070523
Provider Name (Legal Business Name): MAHMOOD A SIDDIQUI MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 11/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 MEDICAL CENTER DR. #B
COPPERHILL TN
37317-5000
US

IV. Provider business mailing address

PO BOX 1162
COPPERHILL TN
37317-1162
US

V. Phone/Fax

Practice location:
  • Phone: 423-496-9214
  • Fax: 423-496-7809
Mailing address:
  • Phone: 423-496-9214
  • Fax: 423-496-7809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD26174
License Number StateTN

VIII. Authorized Official

Name: DR. MAHMOOD ABDUL SIDDIQUI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 423-496-9214