Provider Demographics
NPI:1710996863
Name:SIDDIQUI, SHAGUFTA P (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAGUFTA
Middle Name:P
Last Name:SIDDIQUI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SHAGUFTA
Other - Middle Name:P
Other - Last Name:TAHIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MBBS
Mailing Address - Street 1:29 MENDEN LN
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-9287
Mailing Address - Country:US
Mailing Address - Phone:501-257-5050
Mailing Address - Fax:501-257-5071
Practice Address - Street 1:4300 WEST 7TH STREET
Practice Address - Street 2:VA MEDICAL CENTER
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205
Practice Address - Country:US
Practice Address - Phone:501-257-5050
Practice Address - Fax:501-257-5071
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-2003207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VADOOMedicare UPIN