Provider Demographics
NPI:1356591499
Name:SIDDIQUI, FAISAL M (MD)
Entity type:Individual
Prefix:
First Name:FAISAL
Middle Name:M
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 1:5501 ABERCORN ST STE D-268
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-6911
Mailing Address - Country:US
Mailing Address - Phone:912-232-9700
Mailing Address - Fax:
Practice Address - Street 1:6510 SEAWRIGHT DR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-2752
Practice Address - Country:US
Practice Address - Phone:912-232-9700
Practice Address - Fax:912-235-6387
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-25
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY250128208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03036959Medicaid
NYP00737373Medicare PIN
NY03036959Medicaid