MEDICARE: DR. EHTESHAMUL HAQUE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	0101231617	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	461932	OTHER	ANTHEM BC
2	58013	OTHER	SENTARA OPTIMA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538130810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EHTESHAMUL HAQUE MD

Provider Business Mailing Address
First Line	:	1443 NORTH VEAUX LOOP
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23509-1259
Country	:	US
Telephone Number	:	757-627-3898
Fax Number	:	757-627-0054

Provider Business Practice Location Address
First Line	:	1443 N VEAUX LOOP
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23509-1259
Country	:	US
Telephone Number	:	757-627-3898
Fax Number	:	757-627-0054

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2006
Last Update Date	:	01/12/2008

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