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General NPI Number Information
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NPI Number | 1235114059
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Entity Type | Individual
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Provider Name | MAHMOOD SIDDIQUE M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/14/2005
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Last Update Date | 02/09/2016
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Provider Practice Location Address
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Address Line | 7600 CENTRAL AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19111-2442
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Country | US
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Telephone | 215-728-3714
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Fax | 215-728-3923
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Provider Business Mailing Address
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Address Line | 1271 TRESSLER DR
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City | FORT WASHINGTON
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State | PA
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Zip | 19034-1729
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Country | US
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Telephone | 215-728-3714
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Fax | 215-728-3923
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | MD055412L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | MD055412L
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License Number State | PA
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