Provider Demographics
NPI:1053309419
Name:AKHTAR, AFAQUE (MD)
Entity Type:Individual
Prefix:DR
First Name:AFAQUE
Middle Name:
Last Name:AKHTAR
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 1:409 WAKE CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-1956
Mailing Address - Country:US
Mailing Address - Phone:919-567-9001
Mailing Address - Fax:919-557-5540
Practice Address - Street 1:409 WAKE CHAPEL RD
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-1956
Practice Address - Country:US
Practice Address - Phone:919-567-9001
Practice Address - Fax:919-557-5540
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200401463207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89138NHMedicaid
NC5914157Medicaid
NC5914157Medicaid
NC89138NHMedicaid