Basic Information
| Provider Information | |||||||||
| NPI: | 1447357991 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAQ | ||||||||
| FirstName: | MUHAMMAD | ||||||||
| MiddleName: | WASI | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4301 FERNCREEK DRIVE | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283142543 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9104849302 | ||||||||
| FaxNumber: | 9104849302 | ||||||||
| Practice Location | |||||||||
| Address1: | 1235 RAMSEY ST | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283014401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9104333600 | ||||||||
| FaxNumber: | 9103217103 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2006 | ||||||||
| LastUpdateDate: | 09/13/2017 | ||||||||
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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 | 2084A0401X | 9701386 | NC | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Addiction Medicine | 207Q00000X | 9701386 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 8911004 | 05 | NC | MEDICAID | 11004 | 01 | BLUECROSSBLUESHIELD( BCBS | OTHER |