Provider Demographics
NPI:1861869455
Name:HAQUE, SADIA (OD)
Entity type:Individual
Prefix:DR
First Name:SADIA
Middle Name:
Last Name:HAQUE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 W MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:NEW MARKET
Mailing Address - State:MD
Mailing Address - Zip Code:21774-6279
Mailing Address - Country:US
Mailing Address - Phone:301-865-1800
Mailing Address - Fax:301-865-1973
Practice Address - Street 1:164 W MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:NEW MARKET
Practice Address - State:MD
Practice Address - Zip Code:21774-6279
Practice Address - Country:US
Practice Address - Phone:301-865-1800
Practice Address - Fax:301-865-1973
Is Sole Proprietor?:No
Enumeration Date:2015-08-31
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA2486152W00000X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152W00000XEye and Vision Services ProvidersOptometrist