Provider Demographics
NPI:1639368376
Name:MUSTAFA A. HAQUE, M.D., P.A.
Entity Type:Organization
Organization Name:MUSTAFA A. HAQUE, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MUSTAFA
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAQUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-657-9876
Mailing Address - Street 1:5530 WISCONSIN AVE
Mailing Address - Street 2:SUITE 1660
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-4404
Mailing Address - Country:US
Mailing Address - Phone:301-657-9876
Mailing Address - Fax:301-657-8240
Practice Address - Street 1:5530 WISCONSIN AVE
Practice Address - Street 2:SUITE 1660
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-4404
Practice Address - Country:US
Practice Address - Phone:301-657-9876
Practice Address - Fax:301-657-8229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0053126207X00000X
DC30872207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCG02028Medicare PIN
5441190001Medicare NSC
DCG68346Medicare UPIN