Provider Demographics
NPI:1295118412
Name:SIDDIQUI, FARJAD
Entity type:Individual
Prefix:
First Name:FARJAD
Middle Name:
Last Name:SIDDIQUI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:EMORY UNIVERSITY SCHOOL OF MEDICINE, 1365 CLIFTON ROAD
Mailing Address - Street 2:BLDG B, 6TH FLOOR
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-0001
Mailing Address - Country:US
Mailing Address - Phone:855-366-7989
Mailing Address - Fax:404-712-2617
Practice Address - Street 1:EMORY UNIVERSITY SCHOOL OF MEDICINE, 1365 CLIFTON ROAD
Practice Address - Street 2:BLDG B, 6TH FLOOR
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-0001
Practice Address - Country:US
Practice Address - Phone:855-366-7989
Practice Address - Fax:404-712-2617
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.138401204F00000X, 2086S0102X
390200000X
GA96721208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program