Provider Demographics
NPI:1225351430
Name:SABA SIDDIQI MD PA
Entity Type:Organization
Organization Name:SABA SIDDIQI MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SABA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDDIQI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-687-8777
Mailing Address - Street 1:PO BOX 426
Mailing Address - Street 2:
Mailing Address - City:RIDERWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:21139-0426
Mailing Address - Country:US
Mailing Address - Phone:410-687-8777
Mailing Address - Fax:410-687-1756
Practice Address - Street 1:9106 PHILADELPHIA RD
Practice Address - Street 2:SUITE 204
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-4329
Practice Address - Country:US
Practice Address - Phone:410-687-8777
Practice Address - Fax:410-687-1756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0041496261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD306371200Medicaid
MD306371200Medicaid
MD135QMedicare PIN