1215933221 NPI number — DAVID J HAIDAK M.D.

Table of content: DAVID J HAIDAK M.D. (NPI 1215933221)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215933221 NPI number — DAVID J HAIDAK M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAIDAK
Provider First Name:
DAVID
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1215933221
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8926 WOODYARD RD
Provider Second Line Business Mailing Address:
STE 201
Provider Business Mailing Address City Name:
CLINTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20735-4231
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-868-7911
Provider Business Mailing Address Fax Number:
301-868-2285

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8926 WOODYARD RD
Provider Second Line Business Practice Location Address:
STE 201
Provider Business Practice Location Address City Name:
CLINTON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20735-4231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-868-7911
Provider Business Practice Location Address Fax Number:
301-868-2285
Provider Enumeration Date:
06/23/2005

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: 207RH0003X , with the licence number:  D0017605 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 02810004 . This is a "BC/BS OF DC" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 004052732 . This is a "AETNA MNG" identifier . This identifiers is of the category "OTHER".
  • Identifier: 493216 . This is a "HEALTHLINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 830001307 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 830004072 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 086401 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3000017 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 324510 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 481545 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: B6480002 . This is a "BC/BS OF DC" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 022118900 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 32300002 . This is a "BC/BS OF MD - CLINTON" identifier . This identifiers is of the category "OTHER".
  • Identifier: 32300003 . This is a "BC/BS OF MD - GREENBELT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 324510 . This is a "ALLIANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 058810 . This is a "TRIGON" identifier . This identifiers is of the category "OTHER".
  • Identifier: 04701 . This is a "AMERICAID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 20096 1700 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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