Provider Demographics
NPI:1295848182
Name:SIDDIQUI, KHALID AQUIL (MD)
Entity Type:Individual
Prefix:DR
First Name:KHALID
Middle Name:AQUIL
Last Name:SIDDIQUI
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 1:250 FAME AVENUE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331
Mailing Address - Country:US
Mailing Address - Phone:717-637-2100
Mailing Address - Fax:717-637-2301
Practice Address - Street 1:250 FAME AVENUE
Practice Address - Street 2:SUITE 230
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331
Practice Address - Country:US
Practice Address - Phone:717-637-2100
Practice Address - Fax:717-637-2301
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 052832 L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01564529Medicaid
PA01564529Medicaid
PA836172Medicare ID - Type Unspecified