Provider Demographics
NPI:1801817390
Name:SADIQ, IMMAD (MD)
Entity Type:Individual
Prefix:
First Name:IMMAD
Middle Name:
Last Name:SADIQ
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 1:85 SEYMOUR ST STE 1022
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-5530
Mailing Address - Country:US
Mailing Address - Phone:860-524-3080
Mailing Address - Fax:860-545-3558
Practice Address - Street 1:85 SEYMOUR ST
Practice Address - Street 2:STE. 821
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-5501
Practice Address - Country:US
Practice Address - Phone:860-545-5061
Practice Address - Fax:860-545-3558
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT041880207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008016369Medicaid
CT008016369Medicaid