Provider Demographics
NPI:1689833402
Name:HAQUE, ANWAR MOHAMMED (MD)
Entity Type:Individual
Prefix:DR
First Name:ANWAR
Middle Name:MOHAMMED
Last Name:HAQUE
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 1:3 COOPER PLZ
Mailing Address - Street 2:SUITE 502
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1438
Mailing Address - Country:US
Mailing Address - Phone:856-342-2000
Mailing Address - Fax:609-877-1682
Practice Address - Street 1:218C SUNSET RD
Practice Address - Street 2:
Practice Address - City:WILLINGBORO
Practice Address - State:NJ
Practice Address - Zip Code:08046-1104
Practice Address - Country:US
Practice Address - Phone:609-877-0400
Practice Address - Fax:609-877-1682
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NJMA08914200207RP1001X
NY251151207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJMA08914200OtherMEDICAL LICENSE