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General NPI Number Information
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NPI Number | 1245597160
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Entity Type | Individual
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Provider Name | SOPHIA SIDDIQUI MD
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Gender | Female
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Dates
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Enumeration Date | 04/17/2012
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Last Update Date | 04/17/2012
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Provider Practice Location Address
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Address Line | 8218 WISCONSIN AVE 305
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City | BETHESDA
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State | MD
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Zip | 20814-3107
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Country | US
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Telephone | 301-761-4506
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Fax |
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Provider Business Mailing Address
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Address Line | 11417 PALATINE DR
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City | POTOMAC
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State | MD
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Zip | 20854-1453
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Country | US
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Telephone | 240-899-3369
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Fax |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 1064094
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License Number State | MD
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