Provider Demographics
NPI:1952390205
Name:HAQUE, SYED W (MD)
Entity type:Individual
Prefix:DR
First Name:SYED
Middle Name:W
Last Name:HAQUE
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 1:700 MONTCLAIRE AVENUE
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701
Mailing Address - Country:US
Mailing Address - Phone:301-663-5252
Mailing Address - Fax:301-662-6943
Practice Address - Street 1:700 MONTCLAIRE AVENUE
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4509
Practice Address - Country:US
Practice Address - Phone:301-662-5252
Practice Address - Fax:301-662-6943
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0054636207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD110228878OtherRR MEDICARE
MD024500300Medicaid
MD554RMedicare ID - Type Unspecified
MDHO3527Medicare UPIN