Provider Demographics
NPI:1942468541
Name:SIDDIQUI, SARTAJ KADIWALA (DO)
Entity Type:Individual
Prefix:
First Name:SARTAJ
Middle Name:KADIWALA
Last Name:SIDDIQUI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 HADDONFIELD BERLIN RD STE 210
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-3520
Mailing Address - Country:US
Mailing Address - Phone:856-782-2212
Mailing Address - Fax:856-782-2266
Practice Address - Street 1:101 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-3102
Practice Address - Country:US
Practice Address - Phone:856-782-2212
Practice Address - Fax:856-782-2266
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-30
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS11312208000000X
TXP74752080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal MedicineGroup - Single Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003652900Medicaid
FL14E5QOtherBCBSFL
GA003110020AMedicaid
TX3664609Medicaid