Healthcare Provider Details

I. General information

NPI: 1467470088
Provider Name (Legal Business Name): MOHAMMAD FAREED SIDDIQUI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 02/24/2023
Certification Date: 02/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 SUNSET LN
CULPEPER VA
22701-3917
US

IV. Provider business mailing address

PO BOX 748613
ATLANTA GA
30384-8613
US

V. Phone/Fax

Practice location:
  • Phone: 703-396-5292
  • Fax: 703-396-5297
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0101241424
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: