Provider Demographics
NPI:1194385195
Name:TOGHRAL, SIDDIQUE (MD)
Entity Type:Individual
Prefix:
First Name:SIDDIQUE
Middle Name:
Last Name:TOGHRAL
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 1:3903 FAIR RIDGE DR STE 218
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-2945
Mailing Address - Country:US
Mailing Address - Phone:703-870-3750
Mailing Address - Fax:
Practice Address - Street 1:3903 FAIR RIDGE DR STE 218
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-2945
Practice Address - Country:US
Practice Address - Phone:703-370-8750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-20
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101275815207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty