Healthcare Provider Details

I. General information

NPI: 1932738499
Provider Name (Legal Business Name): SIRAJ HAQ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 2ND AVE APT 3504
SEATTLE WA
98101-3372
US

IV. Provider business mailing address

1430 2ND AVE APT 3504
SEATTLE WA
98101-3372
US

V. Phone/Fax

Practice location:
  • Phone: 541-382-6633
  • Fax:
Mailing address:
  • Phone: 206-245-9502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD230714
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: