Provider Demographics
NPI:1871584979
Name:SIDDIQI, SYED M (MD)
Entity type:Individual
Prefix:DR
First Name:SYED
Middle Name:M
Last Name:SIDDIQI
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 S JEFFERSON ST STE 1006
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24011-1713
Mailing Address - Country:US
Mailing Address - Phone:540-224-5353
Mailing Address - Fax:
Practice Address - Street 1:93 HICKORY DR
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-2834
Practice Address - Country:US
Practice Address - Phone:304-255-9278
Practice Address - Fax:304-255-9278
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV11832207RG0100X
VA0101042422207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0082888000Medicaid
WV0477372Medicare PIN
WV0082888000Medicaid