Provider Demographics
NPI:1518206242
Name:SYED WASIMUL HAQUE MDPA
Entity Type:Organization
Organization Name:SYED WASIMUL HAQUE MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SYED
Authorized Official - Middle Name:
Authorized Official - Last Name:HAQUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-663-5252
Mailing Address - Street 1:700 MONTCLAIRE AVE
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-4577
Mailing Address - Country:US
Mailing Address - Phone:301-663-5252
Mailing Address - Fax:301-662-6943
Practice Address - Street 1:700 MONTCLAIRE AVE
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4577
Practice Address - Country:US
Practice Address - Phone:301-663-5252
Practice Address - Fax:301-662-6943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-31
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD54636207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD024500300Medicaid
554RMedicare PIN
H03527Medicare UPIN