Healthcare Provider Details

I. General information

NPI: 1831171438
Provider Name (Legal Business Name): RIZWAN UL HAQ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 04/27/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 MEDICAL VILLAGE DR
NEWPORT VT
05855-9835
US

IV. Provider business mailing address

189 PROUTY DR MEDICAL ARTS BUILDING
NEWPORT VT
05855-9326
US

V. Phone/Fax

Practice location:
  • Phone: 802-334-3500
  • Fax:
Mailing address:
  • Phone: 802-334-3297
  • Fax: 802-334-3508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number042-0009285
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number042-0009285
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: