Provider Demographics
NPI:1063404911
Name:HAQUE, MAHFUZUL (MD)
Entity type:Individual
Prefix:
First Name:MAHFUZUL
Middle Name:
Last Name:HAQUE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 751069
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1069
Mailing Address - Country:US
Mailing Address - Phone:252-744-3253
Mailing Address - Fax:252-744-3194
Practice Address - Street 1:1800 W 5TH ST
Practice Address - Street 2:SUITE 5
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-2888
Practice Address - Country:US
Practice Address - Phone:252-744-2207
Practice Address - Fax:252-744-1115
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200300110207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP00013007OtherRAILROAD MEDICARE
NC1330EOtherBCBS NC
NC891330EMedicaid
NCH82053Medicare UPIN
NC891330EMedicaid