Provider Demographics
NPI:1659562676
Name:HAIDAR, AQEEL (MD)
Entity Type:Individual
Prefix:
First Name:AQEEL
Middle Name:
Last Name:HAIDAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 GREEN VALLEY RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-7038
Mailing Address - Country:US
Mailing Address - Phone:336-387-2500
Mailing Address - Fax:336-387-2568
Practice Address - Street 1:706 GREEN VALLEY RD
Practice Address - Street 2:SUITE 104
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-7038
Practice Address - Country:US
Practice Address - Phone:336-387-2500
Practice Address - Fax:336-387-2568
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2160271207ZP0102X
PAMD425446207ZP0102X
NC201600534207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH27048Medicare UPIN