Individual provider Active NPI

Mahbubur Siddique, MD

  • Hospitalist Physician
  • Marlton, NJ
National Provider Identifier
1013168467
Registry record updated Jan 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
25MA08472600 Issued in NJ
Practice address
90 Brick Rd FL 3
Marlton, NJ 08053-2177
Phone
(856) 355-6000
Fax
(856) 355-6731
NPI assigned
Oct 3, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 25MA08472600 NJ
Hospitalist Physician 208M00000X 25MA08472600 NJ Primary

Addresses

Primary practice location

90 Brick Rd FL 3
Marlton, NJ 08053-2177

Mailing address

301 Lippincott Dr Ste 410
Marlton, NJ 08053-4197
Phone (856) 355-0340

Other practice location 1

218 Sunset Rd Fl 5
Willingboro, NJ 08046-1110
Phone (609) 444-0599

Other practice location 2

1600 Haddon Ave Fl 6
Camden, NJ 08103-3101
Phone (856) 757-3500

Other practice location 3

175 Madison Ave
Mount Holly, NJ 08060-2099
Phone (609) 914-6000

Other practice location 4

100 Bowman Dr Lowr Level1
Voorhees, NJ 08043-9612
Phone (856) 247-3000

Other identifiers 1

IdentifierTypeStateIssuer
0191884MedicaidNJ

Electronic endpoints 5

TypeEndpointUseAffiliation
Direct Messaging Address msiddique19804@directvirtua.org
Direct Messaging Address msiddique19804@directvirtua.org
Direct Messaging Address msiddique19804@directvirtua.org
Direct Messaging Address msiddique19804@directvirtua.org
Direct Messaging Address msiddique19804@directvirtua.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081217000055 NJ Practitioner - Internal Medicine 7113089780 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Virtua Medical Group, PAGroup PAC ID 9830222397, 1,678 clinicians

Practice addresses (Care Compare)

100 Bowman Dr
Voorhees, NJ 08043-9612
Phone (856) 247-3000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.15 of 100Reported as group
Quality
62.28
Promoting interoperability
100
Improvement activities
40
Cost
74.89

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
25MA08472600NJMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Virtua Medical Group, PA CurrentSince May 1, 2015 Accepting new patients
Virtua Medical Group, PA CurrentSince May 1, 2015 Accepting new patients
Virtua Medical Group, PA Internal Medicine Current Accepting new patients
Cooper Physician Offices, PA Internal Medicine CurrentSince Apr 1, 2015 Accepting new patients
Virtua - West Jersey Health System, Inc. Past Accepting new patients

Locations

3242 Route 206
Ste 2
Bordentown, NJ 08505
Phone (609) 298-4340

1 Cooper Plz
Camden, NJ 08103
Phone (856) 342-2425

1600 Haddon Ave
Fl 6
Camden, NJ 08103
Phone (856) 247-2160

3 Cooper Plz
Rm 215
Camden, NJ 08103
Phone (856) 342-2439

3 Cooper Plz
Rm 500
Camden, NJ 08103
Phone (856) 342-2627

1210 Brace Rd
Cherry Hill, NJ 08034
Phone (609) 428-6616

90 Brick Rd
Fl 3
Marlton, NJ 08053
Phone (856) 247-2160

90 Brick Rd
Marlton, NJ 08053
Phone (856) 355-6040

301 Lippincott Dr
Ste 410
Marlton, NJ 08053

175 Madison Ave
Mount Holly, NJ 08060
Phone (609) 261-1660

7000 Atrium Way
Ste 6
Mount Laurel, NJ 08054
Phone (856) 206-4500

100 Bowman Dr
Lowr
Voorhees, NJ 08043
Phone (856) 247-3000

218 Sunset Rd
Fl 5
Willingboro, NJ 08046
Phone (609) 444-0359

Interoperability endpoints

  • Direct secure messaging: msiddique19804@directvirtua.org

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1222992000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706227200000",
    "number": "1013168467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 LIPPINCOTT DR STE 410",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "080534197",
            "telephone_number": "856-355-0340",
            "fax_number": "856-355-0330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 BRICK RD FL 3",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "080532177",
            "telephone_number": "856-355-6000",
            "fax_number": "856-355-6731"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "218 Sunset Rd Fl 5",
            "address_purpose": "LOCATION",
            "city": "Willingboro",
            "state": "NJ",
            "postal_code": "080461110",
            "country_code": "US",
            "telephone_number": "609-444-0599",
            "fax_number": "609-444-0111",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1600 Haddon Ave Fl 6",
            "address_purpose": "LOCATION",
            "city": "Camden",
            "state": "NJ",
            "postal_code": "081033101",
            "country_code": "US",
            "telephone_number": "856-757-3500",
            "fax_number": "856-365-4088",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "175 Madison Ave",
            "address_purpose": "LOCATION",
            "city": "Mount Holly",
            "state": "NJ",
            "postal_code": "080602099",
            "country_code": "US",
            "telephone_number": "609-914-6000",
            "fax_number": "609-914-6182",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "100 Bowman Dr Lowr Level1",
            "address_purpose": "LOCATION",
            "city": "Voorhees",
            "state": "NJ",
            "postal_code": "080439612",
            "country_code": "US",
            "telephone_number": "856-247-3000",
            "fax_number": "856-247-2597",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SIDDIQUE",
        "first_name": "MAHBUBUR",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-10-03",
        "last_updated": "2024-01-26",
        "certification_date": "2024-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "25MA08472600",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "NJ",
            "license": "25MA08472600",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0191884",
            "state": "NJ"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "msiddique19804@directvirtua.org",
            "affiliation": "N",
            "address_1": "100 Bowman Dr Lowr Level1",
            "city": "Voorhees",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "080439612",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "msiddique19804@directvirtua.org",
            "affiliation": "N",
            "address_1": "90 Brick Rd Fl 3",
            "city": "Marlton",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "080532177",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "msiddique19804@directvirtua.org",
            "affiliation": "N",
            "address_1": "1600 Haddon Ave Fl 6",
            "city": "Camden",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "081033101",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "msiddique19804@directvirtua.org",
            "affiliation": "N",
            "address_1": "175 Madison Ave",
            "city": "Mount Holly",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "080602099",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "msiddique19804@directvirtua.org",
            "affiliation": "N",
            "address_1": "218 Sunset Rd Fl 5",
            "city": "Willingboro",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "080461110",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Marlton, NJ

Sources for this page

Verify at the official NPI Registry.