Provider Demographics
NPI:1255747994
Name:UL HAQ, FAHEEM (MD, MPH)
Entity type:Individual
Prefix:
First Name:FAHEEM
Middle Name:
Last Name:UL HAQ
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:FAHEEM
Other - Middle Name:
Other - Last Name:UL HAQ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1300 HALL BLVD FL 3
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-2918
Mailing Address - Country:US
Mailing Address - Phone:860-714-2376
Mailing Address - Fax:
Practice Address - Street 1:56 FRANKLIN ST STE 1
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06706-1281
Practice Address - Country:US
Practice Address - Phone:203-709-7300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-02
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CT69639207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program