Provider Demographics
NPI:1306815998
Name:SIDDIQI, JAVED I (MD)
Entity Type:Individual
Prefix:
First Name:JAVED
Middle Name:I
Last Name:SIDDIQI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 MERRIMACK ST
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-5870
Mailing Address - Country:US
Mailing Address - Phone:978-689-0033
Mailing Address - Fax:978-682-0033
Practice Address - Street 1:380 MERRIMACK ST
Practice Address - Street 2:SUITE 2C
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-5870
Practice Address - Country:US
Practice Address - Phone:978-689-0033
Practice Address - Fax:978-682-0033
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA56836207V00000X
NH7659207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3013154Medicaid
MA3013154Medicaid
MAJ06622Medicare ID - Type Unspecified