NPIMap

Organization Active NPI

Allegeny Medical LLC

  • Internal Medicine Physician
  • Hagerstown, MD
National Provider Identifier
1821370644
Registry record updated Jun 25, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
ALLEGENY MEDICAL LLC
Practice address
324 East Antietam STR.
Suite 305
Hagerstown, MD 21740-5768
Phone
(301) 791-2510
Fax
(301) 739-7798
NPI assigned
Sep 19, 2011
Last updated
Jun 25, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2013

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

Authorized official

Name
Dr. Shahab Z. Siddiqui, MDNPI 1962448902
Title
MD/Owner
Phone
(301) 791-2510

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 5

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary
Primary Care Clinic/Center 261QP2300X D0072433 MD
Long Term Care Hospital 282E00000X D0072433 MD
Rural Acute Care Hospital 282NR1301X D0072433 MD

Addresses

Primary practice location

324 East Antietam STR.
Suite 305
Hagerstown, MD 21740-5768

Mailing address

324 East Antietam St.
Suite 305
Hagerstown, MD 21740-5768
Phone (301) 791-2510

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130621000097 MD Part B Supplier - Clinic/Group Practice 2860631959 Receives reassigned benefits from 4 practitioners
Practice locations: Hagerstown, MD

National Provider Directory

National Provider Directory

Locations

324 E Antietam St
Ste 305
Hagerstown, MD 21740
Phone (301) 791-2510

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1316390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1372118400000",
    "number": "1821370644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "324 EAST ANTIETAM ST.",
            "address_2": "SUITE 305",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217405768",
            "telephone_number": "301-791-2510",
            "fax_number": "301-739-7798"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "324 EAST ANTIETAM STR.",
            "address_2": "SUITE 305",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217405768",
            "telephone_number": "301-791-2510",
            "fax_number": "301-739-7798"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALLEGENY MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-19",
        "last_updated": "2013-06-25",
        "status": "A",
        "authorized_official_last_name": "SIDDIQUI",
        "authorized_official_first_name": "SHAHAB",
        "authorized_official_middle_name": "Z.",
        "authorized_official_title_or_position": "MD/OWNER",
        "authorized_official_telephone_number": "301-791-2510",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "MD",
            "license": "D0072433",
            "primary": false
        },
        {
            "code": "282E00000X",
            "taxonomy_group": "",
            "desc": "Long Term Care Hospital",
            "state": "MD",
            "license": "D0072433",
            "primary": false
        },
        {
            "code": "282NR1301X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Rural",
            "state": "MD",
            "license": "D0072433",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hagerstown, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.