Provider Demographics
NPI:1447357991
Name:HAQ, MUHAMMAD WASI (MD)
Entity type:Individual
Prefix:DR
First Name:MUHAMMAD
Middle Name:WASI
Last Name:HAQ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4301 FERNCREEK DRIVE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-2543
Mailing Address - Country:US
Mailing Address - Phone:910-484-9302
Mailing Address - Fax:910-484-9302
Practice Address - Street 1:1235 RAMSEY ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-4401
Practice Address - Country:US
Practice Address - Phone:910-433-3600
Practice Address - Fax:910-321-7103
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC97013862084A0401X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8911004Medicaid
11004OtherBLUECROSSBLUESHIELD( BCBS
11004OtherBLUECROSSBLUESHIELD( BCBS
2246127AMedicare ID - Type Unspecified