Provider Demographics
NPI:1063648947
Name:SIDDIQUI, FAISAL AMIN (MD, PHD)
Entity Type:Individual
Prefix:
First Name:FAISAL
Middle Name:AMIN
Last Name:SIDDIQUI
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1498 SE TECH CENTER PL STE 240
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-5508
Mailing Address - Country:US
Mailing Address - Phone:360-597-1300
Mailing Address - Fax:
Practice Address - Street 1:210 SE 136TH AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-6930
Practice Address - Country:US
Practice Address - Phone:360-944-9889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-04
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLL187272085R0001X
WAMD604708492085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology