Provider Demographics
NPI:1588895825
Name:TARIQ, MUDASSAR (MD)
Entity type:Individual
Prefix:DR
First Name:MUDASSAR
Middle Name:
Last Name:TARIQ
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 1:800 BONAVENTURE WAY STE 104
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-8005
Mailing Address - Country:US
Mailing Address - Phone:832-786-0234
Mailing Address - Fax:979-730-3125
Practice Address - Street 1:800 BONAVENTURE WAY STE 104
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-8005
Practice Address - Country:US
Practice Address - Phone:832-786-0234
Practice Address - Fax:832-995-1767
Is Sole Proprietor?:No
Enumeration Date:2009-08-04
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ07062084P0800X, 2084P0802X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry