Provider Demographics
NPI:1730257957
Name:IFTIKHAR, SADIA (MD)
Entity type:Individual
Prefix:
First Name:SADIA
Middle Name:
Last Name:IFTIKHAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 PROSPECT ST STE 205
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-4429
Mailing Address - Country:US
Mailing Address - Phone:401-725-8866
Mailing Address - Fax:401-725-8868
Practice Address - Street 1:126 PROSPECT ST STE 205
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-4429
Practice Address - Country:US
Practice Address - Phone:401-725-8866
Practice Address - Fax:401-725-8868
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD10628207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI04-05011OtherUNITED
RI2202307001OtherCIGNA
RI408532OtherBLUE CHIP
RI27582OtherNEIGHBORHOOD
RI007009039Medicaid
RI2620389OtherAETNA
RI2643-9OtherBLUE CROSS
RI404750OtherTUFTS
RIAA33831OtherHARVARD PILGRIM
RI04-05011OtherUNITED
RI2620389OtherAETNA