Provider Demographics
NPI:1114973922
Name:SIDDIQUI, MERAJ (MD)
Entity Type:Individual
Prefix:
First Name:MERAJ
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 1:125 DENNISON HTS
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-8936
Mailing Address - Country:US
Mailing Address - Phone:870-834-4499
Mailing Address - Fax:870-262-6187
Practice Address - Street 1:1215 SIDNEY ST
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501
Practice Address - Country:US
Practice Address - Phone:870-262-6155
Practice Address - Fax:870-262-6187
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR5039208VP0014X, 207L00000X
ARE4737207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5N520OtherBLUE CROSS OF AR