Basic Information
| Provider Information | |||||||||
| NPI: | 1295290328 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AKBAR | ||||||||
| FirstName: | SIDDIQUE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4408 WALNUT ST APT A1 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191043066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2676735519 | ||||||||
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| Practice Location | |||||||||
| Address1: | 230 N BROAD ST | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191021121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157621172 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2019 | ||||||||
| LastUpdateDate: | 02/03/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | MT216968 | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | MT216968 | 05 | PA | MEDICAID |