Provider Demographics
NPI:1598054025
Name:KHALIQUE, SAMARA MUJEEB (MD)
Entity Type:Individual
Prefix:
First Name:SAMARA
Middle Name:MUJEEB
Last Name:KHALIQUE
Suffix:
Gender:F
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:RMH MEDICAL GROUP
Mailing Address - Street 2:PO BOX 1430
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22803
Mailing Address - Country:US
Mailing Address - Phone:540-689-5700
Mailing Address - Fax:757-431-7156
Practice Address - Street 1:2006 HEALTH CAMPUS DR
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:VA
Practice Address - Zip Code:22801-8679
Practice Address - Country:US
Practice Address - Phone:540-689-5700
Practice Address - Fax:757-431-7146
Is Sole Proprietor?:No
Enumeration Date:2011-04-05
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116027786390200000X
VA0101258427207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program