Provider Demographics
NPI:1497922397
Name:HAQUE, TANIA
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:
Last Name:HAQUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4949 WESTWARD TER
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-5788
Mailing Address - Country:US
Mailing Address - Phone:561-847-1786
Mailing Address - Fax:
Practice Address - Street 1:HUNTER HOLMES MCGUAIRE VA MEDICAL CTR
Practice Address - Street 2:1201 BROAD ROCK BLVD,PRIMARY CARE (BLUE CLINIC )
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23249-7606
Practice Address - Country:US
Practice Address - Phone:804-675-5000
Practice Address - Fax:804-675-6128
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-11
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7673484-1205207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine