Provider Demographics
NPI:1831171438
Name:HAQ, RIZWAN UL (MD)
Entity type:Individual
Prefix:DR
First Name:RIZWAN
Middle Name:UL
Last Name:HAQ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 PROUTY DR
Mailing Address - Street 2:MEDICAL ARTS BUILDING
Mailing Address - City:NEWPORT
Mailing Address - State:VT
Mailing Address - Zip Code:05855-9326
Mailing Address - Country:US
Mailing Address - Phone:802-334-3297
Mailing Address - Fax:802-334-3508
Practice Address - Street 1:41 MEDICAL VILLAGE DR
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:VT
Practice Address - Zip Code:05855-9835
Practice Address - Country:US
Practice Address - Phone:802-334-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-00092852084N0600X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0VN1856Medicaid
G80309Medicare UPIN
VT0VN1856Medicaid