MEDICARE: DR. JAVEDUL HAQUE II MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	35081681	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740253343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAVEDUL HAQUE II MD

Provider Business Mailing Address
First Line	:	2527 MACNAUGHTEN ST NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44720-9529
Country	:	US
Telephone Number	:	330-305-6762
Fax Number	:	330-305-6762

Provider Business Practice Location Address
First Line	:	201 HOSPITAL DR
Second Line	:
City	:	DOVER
State	:	OH
Zip	:	44622-2058
Country	:	US
Telephone Number	:	330-343-6631
Fax Number	:	330-343-8188

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2006
Last Update Date	:	09/29/2008

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