Provider Demographics
NPI:1740268010
Name:SIDDIQUI, MASOOD A (MD, FCCP)
Entity type:Individual
Prefix:
First Name:MASOOD
Middle Name:A
Last Name:SIDDIQUI
Suffix:
Gender:M
Credentials:MD, FCCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5509 KIRKWOOD HWY STE 6
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-5001
Mailing Address - Country:US
Mailing Address - Phone:302-994-4010
Mailing Address - Fax:302-318-9122
Practice Address - Street 1:5509 KIRKWOOD HWY STE 6
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-5001
Practice Address - Country:US
Practice Address - Phone:302-994-4010
Practice Address - Fax:302-318-9122
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06434800207R00000X
DEC1-0007240207RC0200X, 207RS0012X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000032290Medicaid
G37970Medicare UPIN
013792D73Medicare ID - Type Unspecified