Provider Demographics
NPI:1770537326
Name:HAQ, IMRAN UL (MD)
Entity type:Individual
Prefix:DR
First Name:IMRAN
Middle Name:UL
Last Name:HAQ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:10 MAGNOLIA AVENUE
Mailing Address - Street 2:SUITE E
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08302
Mailing Address - Country:US
Mailing Address - Phone:856-455-2399
Mailing Address - Fax:856-451-7791
Practice Address - Street 1:10 MAGNOLIA AVENUE
Practice Address - Street 2:SUITE E
Practice Address - City:BRIDGETON
Practice Address - State:NJ
Practice Address - Zip Code:08302
Practice Address - Country:US
Practice Address - Phone:856-455-2399
Practice Address - Fax:856-451-7791
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXQ9822208600000X
NJMA76219208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0062260Medicaid
NJ078468Medicare ID - Type Unspecified
NJ0062260Medicaid