Provider Demographics
NPI:1720235450
Name:HAQUE, MARYAM S (MD)
Entity Type:Individual
Prefix:
First Name:MARYAM
Middle Name:S
Last Name:HAQUE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:115 KILDAIRE PARK DR STE 406
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-8130
Mailing Address - Country:US
Mailing Address - Phone:919-283-1099
Mailing Address - Fax:984-220-9248
Practice Address - Street 1:115 KILDAIRE PARK DR STE 406
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-8130
Practice Address - Country:US
Practice Address - Phone:919-283-1099
Practice Address - Fax:984-220-9248
Is Sole Proprietor?:No
Enumeration Date:2008-08-25
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2020-00095207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology