Provider Demographics
NPI:1033105408
Name:HAIDER, AGHA W (MD PHD)
Entity Type:Individual
Prefix:
First Name:AGHA
Middle Name:W
Last Name:HAIDER
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 HIOAKS RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-4038
Mailing Address - Country:US
Mailing Address - Phone:804-269-5112
Mailing Address - Fax:877-795-7329
Practice Address - Street 1:909 HIOAKS RD
Practice Address - Street 2:SUITE E
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-4038
Practice Address - Country:US
Practice Address - Phone:804-269-5112
Practice Address - Fax:877-795-7329
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD419248207RC0000X
VA0101247463207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1013280500001Medicaid
VAVAA102350OtherMEDICARE
VA1033105408Medicaid
VAP00863900OtherMEDICARE RAILROAD
PA093314NYVMedicare ID - Type Unspecified
VAA282Medicare PIN
PA1013280500001Medicaid