Provider Demographics
NPI:1932107224
Name:SIDDIQ, SAJID (MD)
Entity Type:Individual
Prefix:
First Name:SAJID
Middle Name:
Last Name:SIDDIQ
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 1:196 CASS AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-4712
Mailing Address - Country:US
Mailing Address - Phone:401-762-3838
Mailing Address - Fax:401-762-8252
Practice Address - Street 1:68 CUMBERLAND ST
Practice Address - Street 2:SUITE 103
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-3323
Practice Address - Country:US
Practice Address - Phone:401-762-3838
Practice Address - Fax:401-762-8252
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMC096369207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7006312Medicaid
RI007060824Medicare PIN
RI007006488Medicare PIN
RI069006280Medicare PIN
RI7006312Medicaid
RI069080039Medicare PIN