Individual
MOSTA GAUSEL HAQUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
301 GOODE WAY, SUITE 201, PORTSMOUTH, VA 23704-2266
(757) 397-0700
(757) 397-8751
Mailing address
301 GOODE WAY, SUITE 201, PORTSMOUTH, VA 23704-2266
(757) 397-0700
(757) 397-8751
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
0101-048420
VA
207RN0300X
Nephrology Physician
Primary
0101-048420
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010236801
—
VA
01
—
187692
ANTHEM BC /BS
VA
01
—
P00273296
RAILROAD MEDICARE
VA
Enumeration date
06/13/2006
Last updated
02/13/2013
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