MEDICARE: DR. MASOOD SIDDIQUEE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	047154	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871551788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MASOOD SIDDIQUEE MD

Provider Business Mailing Address
First Line	:	2080 EASTSIDE DRIVE
Second Line	:	SUITE A
City	:	CONYERS
State	:	GA
Zip	:	30013
Country	:	US
Telephone Number	:	678-625-7800
Fax Number	:	678-625-7888

Provider Business Practice Location Address
First Line	:	2080 EASTSIDE DRIVE
Second Line	:	SUITE A
City	:	CONYERS
State	:	GA
Zip	:	30013
Country	:	US
Telephone Number	:	678-625-7800
Fax Number	:	678-625-7888

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2006
Last Update Date	:	06/21/2010

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