Basic Information
| Provider Information | |||||||||
| NPI: | 1164082905 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SADDIQUE | ||||||||
| FirstName: | AMMAD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 900 JAMES AVE APT 1203A | ||||||||
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| City: | SCRANTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 185101590 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9165799554 | ||||||||
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| Practice Location | |||||||||
| Address1: | 111 N WASHINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | SCRANTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 185031828 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5705915153 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2019 | ||||||||
| LastUpdateDate: | 10/19/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | A176598 | CA | Y | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | MT217339 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.