Basic Information
| Provider Information | |||||||||
| NPI: | 1053615104 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SIDDIQUI | ||||||||
| FirstName: | SARWAT | ||||||||
| MiddleName: | WAQAR | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1600 E GUDE DR | ||||||||
| Address2: | STE 200 | ||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208501496 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3019337133 | ||||||||
| FaxNumber: | 3019337137 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600 E GUDE DR STE 205 | ||||||||
| Address2: | |||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208501497 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3019337133 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2011 | ||||||||
| LastUpdateDate: | 11/29/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | MD037162 | DC | N | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | 207ZP0102X | 0101246187 | VA | N | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | 207ZP0101X | D0075333 | MD | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology |
No ID Information.