Active NPI
Siraj a Siddiqui, MD
- Internal Medicine Physician
- Crestline, OH
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 35065056S
- Legal business name
- SIRAJ A SIDDIQUI, MD
- Practice address
- 216 W Main St
Crestline, OH 44827-1431 - Phone
- (419) 683-8041
- NPI assigned
- Nov 1, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Siraj A Siddiqui, MD
- Title
- Owner
- Phone
- (419) 774-9993
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 35065056S | OH | Primary |
Addresses
Primary practice location
216 W Main St
Crestline, OH 44827-1431
Mailing address
1613 Hidden Oak TRL
Mansfield, OH 44906-3558
Phone (419) 774-9993
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000140397 | Other | OH | ANTHEM |
| 0954347 | Medicaid | OH |
National Provider Directory
National Provider Directory- Tax ID family
- Siraj a Siddiqui MD
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Internal Medicine Physician
- Lexington, OH
- NPI 1497934921
Locations
216 W Main St
Crestline, OH 44827
Phone (419) 683-8041
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1193875200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1193875200000",
"number": "1144409673",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1613 HIDDEN OAK TRL",
"city": "MANSFIELD",
"state": "OH",
"postal_code": "449063558",
"telephone_number": "419-774-9993"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "216 W MAIN ST",
"city": "CRESTLINE",
"state": "OH",
"postal_code": "448271431",
"telephone_number": "419-683-8041"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SIRAJ A SIDDIQUI, MD",
"organizational_subpart": "NO",
"enumeration_date": "2007-11-01",
"last_updated": "2007-11-01",
"status": "A",
"authorized_official_last_name": "SIDDIQUI",
"authorized_official_first_name": "SIRAJ",
"authorized_official_middle_name": "A",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "419-774-9993",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Internal Medicine",
"state": "OH",
"license": "35065056S",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "000000140397",
"state": "OH"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0954347",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Crestline, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.