Provider Demographics
NPI:1639436595
Name:HAQUE, MAHMUDUL (MD)
Entity Type:Individual
Prefix:
First Name:MAHMUDUL
Middle Name:
Last Name:HAQUE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1589 SULPHUR SPRING RD STE 109
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21227-2542
Mailing Address - Country:US
Mailing Address - Phone:443-575-4880
Mailing Address - Fax:443-575-4891
Practice Address - Street 1:25 CROSSROADS DR STE 205
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5533
Practice Address - Country:US
Practice Address - Phone:410-602-7792
Practice Address - Fax:410-602-9889
Is Sole Proprietor?:No
Enumeration Date:2012-04-17
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0079838207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1030893440002Medicaid