Provider Demographics
NPI:1942205000
Name:IKRAM U. HAQUE, MD, PC
Entity Type:Organization
Organization Name:IKRAM U. HAQUE, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IKRAM
Authorized Official - Middle Name:U
Authorized Official - Last Name:HAQUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-534-5700
Mailing Address - Street 1:1111 FRANKLIN ST
Mailing Address - Street 2:STE 210
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-4330
Mailing Address - Country:US
Mailing Address - Phone:814-535-5700
Mailing Address - Fax:814-536-1786
Practice Address - Street 1:1111 FRANKLIN ST
Practice Address - Street 2:STE 210
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-4330
Practice Address - Country:US
Practice Address - Phone:814-535-5700
Practice Address - Fax:814-536-1786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD040357E207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA076574Medicare ID - Type Unspecified