Provider Demographics
NPI:1629000898
Name:HAQUE, MADINA (MD)
Entity Type:Individual
Prefix:DR
First Name:MADINA
Middle Name:
Last Name:HAQUE
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 1:1715 N GEORGE MASON DR STE 404
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22205-3661
Mailing Address - Country:US
Mailing Address - Phone:703-525-2898
Mailing Address - Fax:703-525-4361
Practice Address - Street 1:1715 N GEORGE MASON DR STE 404
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205-3661
Practice Address - Country:US
Practice Address - Phone:703-525-2898
Practice Address - Fax:703-525-4361
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101223906207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101223906OtherSTATE LICENSE NUMBER
VABH6651322OtherDEA
VABH6651322OtherDEA
VA005402R09Medicare ID - Type Unspecified