1356739098 NPI number — JOHN P. HAKIM, MD AND ASSOCIATES

Table of content: (NPI 1356739098)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356739098 NPI number — JOHN P. HAKIM, MD AND ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHN P. HAKIM, MD AND ASSOCIATES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1356739098
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/05/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3195 LACROSSE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DUNKIRK
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20754-2926
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-880-5146
Provider Business Mailing Address Fax Number:
301-856-5444

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7700 OLD BRANCH AVE
Provider Second Line Business Practice Location Address:
SUITE E105
Provider Business Practice Location Address City Name:
CLINTON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20735-1628
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-856-5444
Provider Business Practice Location Address Fax Number:
301-856-5454
Provider Enumeration Date:
01/05/2015

Additional Information

Authorized Official

Authorized Official Last Name:
HAKIM
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
PIERRE
Authorized Official Title or Position:
PHYSCIAN
Authorized Official Telephone Number:
443-880-5146

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  D47748 , 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: 407211100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01010324009 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 03770330 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 159626 . This is a "MEDICARE PTAN" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com