Allegeny Medical LLC
Organization Active NPI Internal Medicine Physician · Hagerstown, MD
NPI 1821370644 · NPPES record last updated Jun 25, 2013
Key facts
- NPI
- 1821370644
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 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
- Organization subpart
- No
Authorized official
- Name
- Dr. Shahab Z. Siddiqui, MD
- Title
- MD/Owner
- Phone
- (301) 791-2510
Practitioners 4
-
Noor Maqsood Siddiqui, M.D.
-
Cristina Butler-Lugo, CRNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MD
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20130621000097 | MD | Part B Supplier - Clinic/Group Practice | 2860631959 |
Receives reassigned benefits from 4 practitioners Practice locations: Hagerstown, MD |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | |||
| Internal Medicine Physician |
207R00000X | Yes | ||
| 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
Other providers in Hagerstown, MD
- Allegany Chiropractic Center, Inc.
- Allegany Dental Care PA
- Allegany Optical LLC
- Allegany Optical LLC
- Allegany Optical LLC
- Allegheny Center for Ambulatory Services
- Allegheny Center for Reconstructive Surgery
- Allegheny Plastic Surgery, Aryeh L Herrera, M.D., P.a.
- Andrea Charlotte Allen
- Crystal Allen
All providers in Hagerstown, MD · Internal Medicine Physician in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 25, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.