Healthcare Provider Details

I. General information

NPI: 1013933563
Provider Name (Legal Business Name): FATEH HRAKY SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 S HANOVER ST SUITE 301
BALTIMORE MD
21225-1233
US

IV. Provider business mailing address

3001 S HANOVER ST SUITE 301
BALTIMORE MD
21225-1233
US

V. Phone/Fax

Practice location:
  • Phone: 410-350-0800
  • Fax:
Mailing address:
  • Phone: 410-350-0800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberD0054042
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: