Provider Demographics
NPI:1164082905
Name:SADDIQUE, AMMAD
Entity Type:Individual
Prefix:
First Name:AMMAD
Middle Name:
Last Name:SADDIQUE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 JAMES AVE APT 1203A
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18510-1590
Mailing Address - Country:US
Mailing Address - Phone:916-579-9554
Mailing Address - Fax:
Practice Address - Street 1:111 N WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18503-1828
Practice Address - Country:US
Practice Address - Phone:570-591-5153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-14
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA176598208M00000X
PAMT217339207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine