Provider Demographics
NPI:1245563436
Name:SIDDIQUI, ADEEL AHMED
Entity Type:Individual
Prefix:DR
First Name:ADEEL
Middle Name:AHMED
Last Name:SIDDIQUI
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 1:755 NORMAN DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-7497
Mailing Address - Country:US
Mailing Address - Phone:272-273-6706
Mailing Address - Fax:717-202-0278
Practice Address - Street 1:755 NORMAN DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-7497
Practice Address - Country:US
Practice Address - Phone:272-273-6706
Practice Address - Fax:717-202-0278
Is Sole Proprietor?:No
Enumeration Date:2009-09-07
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA191956207R00000X
PAMD448536207RN0300X
VA0101253572207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1245563436Medicaid
VV9877AMedicare PIN