Healthcare Provider Details

I. General information

NPI: 1225175714
Provider Name (Legal Business Name): SAROSH F SIDDIQI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1560 N 115TH ST G-10
SEATTLE WA
98133-8414
US

IV. Provider business mailing address

9809 NE 30TH ST G-10
BELLEVUE WA
98004-1840
US

V. Phone/Fax

Practice location:
  • Phone: 260-368-1558
  • Fax: 206-368-5751
Mailing address:
  • Phone: 253-347-2606
  • Fax: 561-282-3238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number01079807A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMD00042673
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD00042673
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD00042673
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberMD00042673
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: