Provider Demographics
NPI:1649268665
Name:SIDDIQUI, AQEEL AHMED (MD)
Entity type:Individual
Prefix:
First Name:AQEEL
Middle Name:AHMED
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 1:100 E LANCASTER AVE STE 130
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3453
Mailing Address - Country:US
Mailing Address - Phone:610-649-1175
Mailing Address - Fax:610-896-8753
Practice Address - Street 1:100 E LANCASTER AVE STE 130
Practice Address - Street 2:
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3453
Practice Address - Country:US
Practice Address - Phone:610-649-1175
Practice Address - Fax:610-896-8753
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD067368L207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017889600001Medicaid
PA0017889600001Medicaid
PA035716Medicare ID - Type Unspecified