Provider Demographics
NPI:1780682591
Name:HAQUE, MUSTAFA A (MD)
Entity Type:Individual
Prefix:
First Name:MUSTAFA
Middle Name:A
Last Name:HAQUE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5530 WISCONSIN AVENUE
Mailing Address - Street 2:SUITE 1660
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815
Mailing Address - Country:US
Mailing Address - Phone:301-657-9876
Mailing Address - Fax:301-657-8229
Practice Address - Street 1:5530 WISCONSIN AVENUE
Practice Address - Street 2:SUITE 1660
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815
Practice Address - Country:US
Practice Address - Phone:301-657-9876
Practice Address - Fax:301-657-8229
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0053126207X00000X
DC30872207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCG02028M01Medicare PIN
DCG68346Medicare UPIN
5441190001Medicare NSC