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General NPI Number Information
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NPI Number | 1720235450
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Entity Type | Individual
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Provider Name | MARYAM S HAQUE MD
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Gender | Female
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Dates
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Enumeration Date | 08/25/2008
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Last Update Date | 02/02/2022
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Provider Practice Location Address
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Address Line | 115 KILDAIRE PARK DR STE 406
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City | CARY
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State | NC
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Zip | 27518-8130
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Country | US
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Telephone | 919-283-1099
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Fax | 984-220-9248
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Provider Business Mailing Address
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Address Line | 115 KILDAIRE PARK DR STE 406
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City | CARY
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State | NC
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Zip | 27518-8130
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Country | US
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Telephone | 919-283-1099
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Fax | 984-220-9248
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 2020-00095
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License Number State | NC
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