Provider Demographics
NPI:1427745025
Name:ELSIDDIG, OSMAN OMER (MD)
Entity type:Individual
Prefix:
First Name:OSMAN
Middle Name:OMER
Last Name:ELSIDDIG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1329 FULTON ST APT 2F
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-2114
Mailing Address - Country:US
Mailing Address - Phone:347-350-0041
Mailing Address - Fax:
Practice Address - Street 1:ONE BOSTON MEDICAL CENTER PL, BOSTON, MA 02118
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118
Practice Address - Country:US
Practice Address - Phone:617-638-6975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program