Healthcare Provider Details

I. General information

NPI: 1508849886
Provider Name (Legal Business Name): SHAIKH R HOQUE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 01/16/2020
Certification Date: 01/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 MOONSTONE CT
NASHUA NH
03062-3097
US

IV. Provider business mailing address

12 MOONSTONE CT
NASHUA NH
03062-3097
US

V. Phone/Fax

Practice location:
  • Phone: 406-788-7119
  • Fax:
Mailing address:
  • Phone: 406-788-7119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number12878
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number12878
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: