Provider Demographics
NPI:1073712725
Name:SIDDIQUI, SOHAIB (MD)
Entity Type:Individual
Prefix:
First Name:SOHAIB
Middle Name:
Last Name:SIDDIQUI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 125
Mailing Address - Street 2:
Mailing Address - City:CENTER CONWAY
Mailing Address - State:NH
Mailing Address - Zip Code:03813-0125
Mailing Address - Country:US
Mailing Address - Phone:603-730-5356
Mailing Address - Fax:603-730-5477
Practice Address - Street 1:1857 WHITE MOUNTAIN HWY
Practice Address - Street 2:
Practice Address - City:NORTH CONWAY
Practice Address - State:NH
Practice Address - Zip Code:03860-5158
Practice Address - Country:US
Practice Address - Phone:603-387-4523
Practice Address - Fax:603-730-5477
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD19943207Q00000X
NH13603207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3072732Medicaid
NH3072732Medicaid