Provider Demographics
NPI:1336398833
Name:SIDDIQUI, ABU TAHER (MD,)
Entity Type:Individual
Prefix:DR
First Name:ABU TAHER
Middle Name:
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 1:10000 BAY PIINE BLVD
Mailing Address - Street 2:BAY PINE VA HEALTH CARE SYSTEM
Mailing Address - City:BAY PINE
Mailing Address - State:FL
Mailing Address - Zip Code:33744
Mailing Address - Country:US
Mailing Address - Phone:727-398-6661
Mailing Address - Fax:
Practice Address - Street 1:10000 BAY PINE BLVD
Practice Address - Street 2:BAY PINE VA HEALTH CARE SYSTEM
Practice Address - City:BAY PINE
Practice Address - State:FL
Practice Address - Zip Code:33744
Practice Address - Country:US
Practice Address - Phone:727-398-6661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME102882207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine