NPIMap

Shahab Z Siddiqui, MD

Individual provider Active NPI Sports Medicine (Family Medicine) Physician · Hagerstown, MD

NPI 1962448902 · NPPES record last updated Oct 4, 2012

Key facts

NPI
1962448902
Entity type
Individual (NPI type 1)
Primary specialty
Sports Medicine (Family Medicine) Physician 207QS0010X
License
D45031 (MD)
Practice address
324 E Antietam St Ste 305
Hagerstown, MD 21740-5768
Phone
(301) 791-2510
Fax
(301) 739-7798
NPI assigned
Jun 20, 2006
Sex
Male
Sole proprietor
No

Organizations & group practices 11

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 5

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

Medicare Care Compare profile

Specialty
Internal Medicine
Education
Other, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Meritus Medical Center Inc (730 clinicians)
Allegeny Medical LLC (2 clinicians)

Practice addresses (Care Compare)

11110 Medical Campus Rd
Hagerstown, MD 21742-6700

324 E Antietam St
Suite 200
Hagerstown, MD 21740-5792
Phone (301) 791-2510

Hospital & facility affiliations

  • Home Call Home health agency · Frederick, MD · CCN 217040
  • Meritus Medical Center, Inc Home health agency · Hagerstown, MD · CCN 217085
  • Wellspan Waynesboro Hospital Hospital · Waynesboro, PA · CCN 390138

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

Medicare participation

Medicare fee-for-service enrollment
Enrolled in MD
Eligible to order & refer
Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
I20081107000485 MD Practitioner - Internal Medicine 9537228770 Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD)
Yes
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Allegeny Medical LLC Current
since Jul 1, 2013		 Accepting new patients
Meritus Medical Center Inc Past Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
Meritus Medical Laboratory LLC Past Accepting new patients

Locations

324 E Antietam St
Ste 200
Hagerstown, MD 21740
Phone (301) 791-2510

11116 Medical Campus Rd
Hagerstown, MD 21742
Phone (301) 766-7600

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

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Family Medicine) Physician 207QS0010X D45031 MD Yes

Addresses

Primary practice location

324 E Antietam St Ste 305
Hagerstown, MD 21740-5768

Mailing address

324 E Antietam St Ste 305
Hagerstown, MD 21740-5768
Phone (301) 791-2510

Other identifiers

IdentifierTypeStateIssuer
044221600MedicaidMD

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 4, 2012.

{
    "created_epoch": "1150761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1349308800000",
    "number": "1962448902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "324 E ANTIETAM ST STE 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 E ANTIETAM ST STE 305",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217405768",
            "telephone_number": "301-791-2510",
            "fax_number": "301-739-7798"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIDDIQUI",
        "first_name": "SHAHAB",
        "middle_name": "Z",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-20",
        "last_updated": "2012-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "MD",
            "license": "D45031",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "044221600",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hagerstown, MD

All providers in Hagerstown, MD · Sports Medicine (Family Medicine) Physician in Maryland

Sources for this page

Verify at the official NPI Registry.