Individual
MUSTAFA S SIDDIQUI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
(336) 716-9016
Mailing address
PO BOX 344, WINSTON SALEM, NC 27102-0344
(336) 716-2255
(336) 716-9016
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
2006-00924
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10384605
—
VA
01
—
142R4
BCBS
—
01
—
190067
MEDCOST
—
05
—
3810008600
—
WV
05
—
5906370
—
NC
01
—
7616819
AETNA
—
01
—
808467
PARTNERS
—
01
—
P00398024
RR MEDICARE
—
Enumeration date
07/21/2006
Last updated
11/12/2010
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