Healthcare Provider Details

I. General information

NPI: 1922346832
Provider Name (Legal Business Name): FARIS Z HAKKI, M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2013
Last Update Date: 01/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 IRVING ST NW POB 408
WASHINGTON DC
20010-2927
US

IV. Provider business mailing address

106 IRVING ST NW POB 408
WASHINGTON DC
20010-2927
US

V. Phone/Fax

Practice location:
  • Phone: 301-943-1646
  • Fax: 410-721-6363
Mailing address:
  • Phone: 301-943-1646
  • Fax: 410-721-6363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberMD21291
License Number StateDC

VIII. Authorized Official

Name: FARIS Z HAKKI
Title or Position: SOLE OWNER
Credential: MD
Phone: 301-943-1646