Provider Demographics
NPI:1740253343
Name:HAQUE, JAVEDUL II (MD)
Entity type:Individual
Prefix:DR
First Name:JAVEDUL
Middle Name:
Last Name:HAQUE
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2527 MACNAUGHTEN ST NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-9529
Mailing Address - Country:US
Mailing Address - Phone:330-305-6762
Mailing Address - Fax:330-305-6762
Practice Address - Street 1:201 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-2058
Practice Address - Country:US
Practice Address - Phone:330-343-6631
Practice Address - Fax:330-343-8188
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH350816812084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH85205Medicare UPIN
OHHA4113243Medicare PIN