Healthcare Provider Details

I. General information

NPI: 1639368376
Provider Name (Legal Business Name): MUSTAFA A. HAQUE, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2007
Last Update Date: 03/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5530 WISCONSIN AVE SUITE 1660
CHEVY CHASE MD
20815-4404
US

IV. Provider business mailing address

5530 WISCONSIN AVE SUITE 1660
CHEVY CHASE MD
20815-4404
US

V. Phone/Fax

Practice location:
  • Phone: 301-657-9876
  • Fax: 301-657-8229
Mailing address:
  • Phone: 301-657-9876
  • Fax: 301-657-8240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberD0053126
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number30872
License Number StateDC

VIII. Authorized Official

Name: DR. MUSTAFA A HAQUE
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 301-657-9876