Provider Demographics
NPI:1508068115
Name:SIDDIQUI, AHSAN B (MD)
Entity Type:Individual
Prefix:DR
First Name:AHSAN
Middle Name:B
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 1:3106 BUDS CIR
Mailing Address - Street 2:
Mailing Address - City:WINDSOR MILL
Mailing Address - State:MD
Mailing Address - Zip Code:21244-2082
Mailing Address - Country:US
Mailing Address - Phone:410-737-5667
Mailing Address - Fax:
Practice Address - Street 1:4620 S LABURNUM AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23231-2424
Practice Address - Country:US
Practice Address - Phone:804-652-2200
Practice Address - Fax:804-222-0458
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD72070207Q00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC05700OtherGROUP PTAN
VAC05700OtherGROUP PTAN
VA018303B69Medicare PIN
VAFS0977984OtherDEA