Provider Demographics
NPI:1285434795
Name:SIDDIQUI, BAILIE (CBS)
Entity type:Individual
Prefix:
First Name:BAILIE
Middle Name:
Last Name:SIDDIQUI
Suffix:
Gender:
Credentials:CBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1686 ALBERMARLE DR
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-2001
Mailing Address - Country:US
Mailing Address - Phone:443-333-7724
Mailing Address - Fax:
Practice Address - Street 1:1686 ALBERMARLE DR
Practice Address - Street 2:
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-2001
Practice Address - Country:US
Practice Address - Phone:443-333-7724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-14
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN