NPIMap

Individual provider Active NPI

Muhammad Kamran Siddique, MD

  • Medical Oncology Physician
  • Centreville, MD
National Provider Identifier
1740426774
Registry record updated Apr 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Oncology PhysicianTaxonomy code 207RX0202X
License
D0076690 Issued in MD
Practice address
2977 Four H Park Rd Ste 102
Centreville, MD 21617-2237
Phone
(410) 758-4030
Fax
(107) 584-7334
NPI assigned
Dec 22, 2008
Last updated
Apr 5, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology & Oncology Physician 207RH0003X 40042 KY
Medical Oncology Physician 207RX0202X D0076690 MD Primary

Addresses

Primary practice location

2977 Four H Park Rd Ste 102
Centreville, MD 21617-2237

Mailing address

PO Box 749495
Atlanta, GA 30374-9495
Phone (239) 432-8331

Other identifiers 2

IdentifierTypeStateIssuer
7100062280MedicaidKY
000000598659OtherKYANTHEM BCBS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200916001273 MD Practitioner - Internal Medicine 3173543774 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
American Oncology Partners PAGroup PAC ID 0042569758, 377 clinicians

Practice addresses (Care Compare)

8221 Teal Dr
Suite 302
Easton, MD 21601-7215
Phone (410) 820-5945

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
D0076690MDMDMedical Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Bay Hematology Oncology PA Hematology & Oncology CurrentSince Nov 1, 2021 Accepting new patients
Luminis Health Medical Group, LLC Current Accepting new patients
American Oncology Partners PA Hematology & Oncology CurrentSince Jun 1, 2024 Accepting new patients
Luminis Health Medical Group, LLC CurrentSince Oct 18, 2020 Accepting new patients
Luminis Health Medical Group, LLC CurrentSince Oct 18, 2020 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

2001 Medical Pkwy
Annapolis, MD 21401
Phone (410) 280-5601

2003 Medical Pkwy
Ste 210
Annapolis, MD 21401
Phone (410) 571-5300

2003 Medical Pkwy
Ste 301
Annapolis, MD 21401
Phone (443) 481-3366

2977 Four H Park Rd
Ste 102
Centreville, MD 21617
Phone (410) 758-4030

8221 Teal Dr
Ste 301
Easton, MD 21601
Phone (410) 820-5945

8221 Teal Dr
Ste 302
Easton, MD 21601
Phone (410) 820-5945

Organizations & group practices 6

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

Hospital & facility affiliations 8

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": "1229904000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712275200000",
    "number": "1740426774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 749495",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303749495",
            "telephone_number": "239-432-8331",
            "fax_number": "813-321-1296"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2977 FOUR H PARK RD STE 102",
            "city": "CENTREVILLE",
            "state": "MD",
            "postal_code": "216172237",
            "telephone_number": "410-758-4030",
            "fax_number": "107-584-7334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIDDIQUE",
        "first_name": "MUHAMMAD",
        "middle_name": "KAMRAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-12-22",
        "last_updated": "2024-04-05",
        "certification_date": "2024-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "KY",
            "license": "40042",
            "primary": false
        },
        {
            "code": "207RX0202X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Medical Oncology",
            "state": "MD",
            "license": "D0076690",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100062280",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "000000598659",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Centreville, MD

Sources for this page

Verify at the official NPI Registry.