Provider Demographics
NPI:1922022383
Name:SIDDIQUI, REHAN A (MD)
Entity Type:Individual
Prefix:
First Name:REHAN
Middle Name:A
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 1:55 FRUIT ST
Mailing Address - Street 2:GRAY-BIGELOW 444
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2621
Mailing Address - Country:US
Mailing Address - Phone:617-726-3030
Mailing Address - Fax:617-726-5985
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:GRAY-BIGELOW 444
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-726-3030
Practice Address - Fax:617-726-5985
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301083378207L00000X
MA243085207L00000X
MN53191207L00000X
IN01060415A207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4837352Medicaid
MI4837352Medicaid
0F14537025Medicare ID - Type Unspecified