Basic Information
| Provider Information | |||||||||
| NPI: | 1235457748 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAQUE | ||||||||
| FirstName: | TANVIR | ||||||||
| MiddleName: | REZWAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2417 ATRIUM DR STE 150 | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276076673 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197912040 | ||||||||
| FaxNumber: | 9197912041 | ||||||||
| Practice Location | |||||||||
| Address1: | 2417 ATRIUM DR STE 150 | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276076673 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197912040 | ||||||||
| FaxNumber: | 9197912041 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2010 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 2013-00615 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RT0003X | 2013-00615 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine | Transplant Hepatology | 207RG0100X | 2013-00615 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.