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General NPI Number Information
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NPI Number | 1740420231
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Entity Type | Organization
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Legal Business Name | CENTER FOR INTERVENTIONAL PAIN MANGEMENT PC
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Dates
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Enumeration Date | 02/24/2009
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Last Update Date | 09/28/2015
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Provider Practice Location Address
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Address Line | 6164 FULLER CT
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City | ALEXANDRIA
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State | VA
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Zip | 22310-2540
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Country | US
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Telephone | 571-257-9426
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Fax | 571-257-9839
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Provider Business Mailing Address
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Address Line | 6164 FULLER CT
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City | ALEXANDRIA
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State | VA
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Zip | 22310-2540
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Country | US
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Telephone | 571-257-9426
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Fax | 571-257-9839
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Authorized Official
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Title or Position | DIRECTOR
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Name | TALHA SIDDIQUI
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Credential | M.D
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Telephone | 804-832-3424
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 0101233817
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License Number State | VA
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