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General NPI Number Information
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NPI Number | 1942723986
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Entity Type | Individual
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Provider Name | WALEED TARIQ SIDDIQUI MD
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Gender | Male
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Dates
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Enumeration Date | 07/21/2017
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Last Update Date | 07/07/2022
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Provider Practice Location Address
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Address Line | 365 MONTAUK AVE
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City | NEW LONDON
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State | CT
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Zip | 06320-4700
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Country | US
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Telephone | 203-583-7141
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Fax |
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Provider Business Mailing Address
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Address Line | 185 CANAL ST UNIT 3024
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City | SHELTON
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State | CT
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Zip | 06484-8136
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Country | US
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Telephone |
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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 | 66455
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License Number State | CT
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