Healthcare Provider Details

I. General information

NPI: 1740253343
Provider Name (Legal Business Name): JAVEDUL HAQUE II MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 09/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 HOSPITAL DR
DOVER OH
44622-2058
US

IV. Provider business mailing address

2527 MACNAUGHTEN ST NW
CANTON OH
44720-9529
US

V. Phone/Fax

Practice location:
  • Phone: 330-343-6631
  • Fax: 330-343-8188
Mailing address:
  • Phone: 330-305-6762
  • Fax: 330-305-6762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35081681
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: