NPIMap

Individual provider Active NPI

Max Mahfuzul Haque, M.D.

  • Psychiatry Physician
  • Logan, OH
National Provider Identifier
1700884111
Registry record updated Jun 3, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
35-07-0607-H Issued in OH
Practice address
1389 W Hunter St
Logan, OH 43138-1013
Phone
(740) 385-2197
Fax
(740) 385-9197
NPI assigned
Jul 9, 2005
Last updated
Jun 3, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 35-07-0607-H OH Primary

Addresses

Primary practice location

1389 W Hunter St
Logan, OH 43138-1013

Mailing address

PO Box 228
Logan, OH 43138-0228
Phone (740) 380-4181

Other identifiers 2

IdentifierTypeStateIssuer
35070607HOtherOHSTATE LICENSE
2050999MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040227000155 OH Practitioner - Psychiatry 9436045234 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 1974
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Ohio Psychiatric Services LLCGroup PAC ID 1850689266, 5 clinicians
Psychiatric Services and TMS Center LLCGroup PAC ID 9335527480, 6 clinicians

Practice addresses (Care Compare)

5551 Hilliard Rome Office Park
Hilliard, OH 43026-7287
Phone (740) 201-6021

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Ohio Psychiatric Services LLC. CurrentSince Jun 1, 2019 Accepting new patients
C G Reddy MD Inc Past Accepting new patients
Professional Development Services Inc PastSince Aug 1, 2001 Accepting new patients
Pennsylvania Department of Public Welfare Past Accepting new patients
Holistic Wellness Solutions LLC PastSince Feb 8, 2023 Accepting new patients
Hocking Hills Family Counseling & Psychiatry, Inc. Psychiatry Past Accepting new patients
Ohio State University Past Accepting new patients

Locations

5551 Hilliard Rome Office Park
Hilliard, OH 43026
Phone (614) 850-0500

109 N Broad St
Ste 304
Lancaster, OH 43130
Phone (740) 201-6021

Interoperability endpoints

  • Direct secure messaging: ohiopsychiatricservicesllc.maxhaque@143075.advancedmd-direct.com

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1120867200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559520000000",
    "number": "1700884111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 228",
            "city": "LOGAN",
            "state": "OH",
            "postal_code": "431380228",
            "telephone_number": "740-380-4181",
            "fax_number": "740-385-0865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1389 W HUNTER ST",
            "city": "LOGAN",
            "state": "OH",
            "postal_code": "431381013",
            "telephone_number": "740-385-2197",
            "fax_number": "740-385-9197"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAQUE",
        "first_name": "MAX",
        "middle_name": "MAHFUZUL",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-09",
        "last_updated": "2019-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "OH",
            "license": "35-07-0607-H",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "35070607H",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2050999",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Logan, OH

Sources for this page

Verify at the official NPI Registry.