Healthcare Provider Details

I. General information

NPI: 1407011604
Provider Name (Legal Business Name): ZAKI HASSAN T AL HASHEM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2008
Last Update Date: 03/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 INDEPENDENCE DR
CHESTNUT HILL MA
02467-3614
US

IV. Provider business mailing address

1 CHILDRENS WAY STE 203
LITTLE ROCK AR
72202-3500
US

V. Phone/Fax

Practice location:
  • Phone: 909-520-7353
  • Fax:
Mailing address:
  • Phone: 501-364-2919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberE-12050
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number237402
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: