Healthcare Provider Details

I. General information

NPI: 1275108987
Provider Name (Legal Business Name): DIAA A HAKIM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2021
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 SUMMER ST
WORCESTER MA
01608-1216
US

IV. Provider business mailing address

123 SUMMER ST
WORCESTER MA
01608-1216
US

V. Phone/Fax

Practice location:
  • Phone: 508-363-5000
  • Fax:
Mailing address:
  • Phone: 617-732-4860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number3019894
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: