Provider Demographics
NPI:1821370644
Name:ALLEGENY MEDICAL LLC
Entity Type:Organization
Organization Name:ALLEGENY MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHAB
Authorized Official - Middle Name:Z
Authorized Official - Last Name:SIDDIQUI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-791-2510
Mailing Address - Street 1:324 EAST ANTIETAM ST.
Mailing Address - Street 2:SUITE 305
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-5768
Mailing Address - Country:US
Mailing Address - Phone:301-791-2510
Mailing Address - Fax:301-739-7798
Practice Address - Street 1:324 EAST ANTIETAM STR.
Practice Address - Street 2:SUITE 305
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5768
Practice Address - Country:US
Practice Address - Phone:301-791-2510
Practice Address - Fax:301-739-7798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-19
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 207R00000X
MDD0072433261QP2300X, 282E00000X, 282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No282E00000XHospitalsLong Term Care HospitalGroup - Multi-Specialty
No282NR1301XHospitalsGeneral Acute Care HospitalRuralGroup - Multi-Specialty