Provider Demographics
NPI:1437110053
Name:SIDDIQUI, SALMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SALMAN
Middle Name:
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 1:269 MEDICAL PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23805-9337
Mailing Address - Country:US
Mailing Address - Phone:804-861-0700
Mailing Address - Fax:804-863-4626
Practice Address - Street 1:207 N 4TH AVE
Practice Address - Street 2:
Practice Address - City:HOPEWELL
Practice Address - State:VA
Practice Address - Zip Code:23860-2503
Practice Address - Country:US
Practice Address - Phone:804-541-0918
Practice Address - Fax:804-541-7924
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012276432084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2042750OtherCIGNA
VA258008OtherHEALTHKEEPERS
VAP00208843OtherRR MEDICARE
VA258007OtherHEALTHKEEPERS
VA270038OtherTRICARE
VA258007OtherANTHEM
VA004945115Medicaid
VA153652OtherVALUE OPTIONS
VA286973OtherANTHEM BLUE CROSS BLUE SHIELD
VAO83614Medicaid
VA258008OtherANTHEM
VA7087304OtherAETNA
VAO083614Medicaid
VA007114729Medicaid
VAO83614OtherSOUTHERN HEALTH
VA258008Medicaid
VAG98949Medicare UPIN
VA270038OtherTRICARE
VA002674M13Medicare ID - Type UnspecifiedMEDICARE
VA002724M81Medicare ID - Type UnspecifiedMEDICARE
260002848Medicare PIN