Healthcare Provider Details

I. General information

NPI: 1801086673
Provider Name (Legal Business Name): RAFAZ HOQUE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2007
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 WADSWORTH DR
NORTH CHESTERFIELD VA
23236-4510
US

IV. Provider business mailing address

165 WADSWORTH DR
NORTH CHESTERFIELD VA
23236-4500
US

V. Phone/Fax

Practice location:
  • Phone: 804-330-4021
  • Fax:
Mailing address:
  • Phone: 804-330-4901
  • Fax: 804-330-9141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD463968
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: