Basic Information
| Provider Information | |||||||||
| NPI: | 1437412566 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SADIQ | ||||||||
| FirstName: | AWAIL | ||||||||
| MiddleName: | U | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12070 OLD LINE CTR STE 303 | ||||||||
| Address2: | |||||||||
| City: | WALDORF | ||||||||
| State: | MD | ||||||||
| PostalCode: | 206023535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016455100 | ||||||||
| FaxNumber: | 3018932861 | ||||||||
| Practice Location | |||||||||
| Address1: | 12070 OLD LINE CTR STE 303 | ||||||||
| Address2: | |||||||||
| City: | WALDORF | ||||||||
| State: | MD | ||||||||
| PostalCode: | 206023535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016455100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2012 | ||||||||
| LastUpdateDate: | 08/06/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0011X | PENDING | NE | N | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | 207RC0000X | 7407 | NE | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.