Provider Demographics
NPI:1073930152
Name:SEDDIQ, MARJILLA
Entity Type:Individual
Prefix:DR
First Name:MARJILLA
Middle Name:
Last Name:SEDDIQ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10412 NELLIE WHITE LN
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22032-3821
Mailing Address - Country:US
Mailing Address - Phone:703-309-9442
Mailing Address - Fax:
Practice Address - Street 1:355 BARD AVE
Practice Address - Street 2:ROOM 314
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10310-1664
Practice Address - Country:US
Practice Address - Phone:718-818-4636
Practice Address - Fax:718-818-2739
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-26
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101263319208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics