1154393213 NPI number — FAITH ALICE HACKETT MD

Table of content: (NPI 1447380787)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154393213 NPI number — FAITH ALICE HACKETT MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HACKETT
Provider First Name:
FAITH
Provider Middle Name:
ALICE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154393213
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
844 RITCHIE HWY
Provider Second Line Business Mailing Address:
SUITE 206
Provider Business Mailing Address City Name:
SEVERNA PARK
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21146
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-647-8300
Provider Business Mailing Address Fax Number:
410-315-8444

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
844 RITCHIE HWY
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
SEVERNA PARK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21146
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-647-8300
Provider Business Practice Location Address Fax Number:
410-315-8444
Provider Enumeration Date:
02/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  D32426 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 2080A0000X , with the licence number: D32426 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 03794 . This is a "AMERICAID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0H64 . This is a "CBCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 11120 . This is a "BS POS" identifier . This identifiers is of the category "OTHER".
  • Identifier: OH64 . This is a "BS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0553696119 . This is a "UHC HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 06704 . This is a "PHN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 726556 . This is a "US AETNA (HMO)" identifier . This identifiers is of the category "OTHER".
  • Identifier: 811265 . This is a "MD/OP/ALLIANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: T593001 . This is a "BLUE CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4077FA . This is a "MC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 38000 . This is a "EHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 38000 . This is a "PRIORITY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4338237 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: T5930001 . This is a "BSFED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 38000 . This is a "JHEHP" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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