Provider Demographics
NPI:1528406196
Name:HAQUE, OMAR (MD, PHD)
Entity Type:Individual
Prefix:
First Name:OMAR
Middle Name:
Last Name:HAQUE
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 1:1101 BEACON ST
Mailing Address - Street 2:SUITE 1W
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-5587
Mailing Address - Country:US
Mailing Address - Phone:617-855-7288
Mailing Address - Fax:844-733-6150
Practice Address - Street 1:1101 BEACON ST STE 1W
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5587
Practice Address - Country:US
Practice Address - Phone:617-855-7288
Practice Address - Fax:844-733-6150
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-05
Last Update Date:2017-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILP029332084P0800X
MA2699362084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry