Basic Information
Provider Information
NPI: 1932469608
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HAQUE
FirstName: AHMED
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 111 COLCHESTER AVE.
Address2: UVM MEDICAL CENTER, DEPT. OF ANESTHESIOLOGY
City: BURLINGTON
State: VT
PostalCode: 05401
CountryCode: US
TelephoneNumber: 8028472415
FaxNumber: 8028475324
Practice Location
Address1: 111 COLCHESTER AVE.
Address2: UVM MEDICAL CENTER, DEPT. OF ANESTHESIOLOGY
City: BURLINGTON
State: VT
PostalCode: 05401
CountryCode: US
TelephoneNumber: 8028472415
FaxNumber: 8028475324
Other Information
ProviderEnumerationDate: 05/29/2012
LastUpdateDate: 02/24/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000X060.0004419VTY Allopathic & Osteopathic PhysiciansAnesthesiology 
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


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