Provider Demographics
NPI:1144610759
Name:SIDDIQ, HAARIS (MD)
Entity Type:Individual
Prefix:DR
First Name:HAARIS
Middle Name:
Last Name:SIDDIQ
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 1:901 HARRY S TRUMAN DR N STE 4217
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5477
Mailing Address - Country:US
Mailing Address - Phone:240-677-0236
Mailing Address - Fax:
Practice Address - Street 1:901 HARRY S TRUMAN DR N STE 4217
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5477
Practice Address - Country:US
Practice Address - Phone:240-677-0236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-03
Last Update Date:2023-03-28
Deactivation Date:2023-03-21
Deactivation Code:
Reactivation Date:2023-03-27
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty