Healthcare Provider Details

I. General information

NPI: 1730137688
Provider Name (Legal Business Name): JOHN P. HAKIM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 12/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 OLD BRANCH AVE STE E105
CLINTON MD
20735-1628
US

IV. Provider business mailing address

7700 OLD BRANCH AVE STE E105
CLINTON MD
20735-1628
US

V. Phone/Fax

Practice location:
  • Phone: 301-856-5444
  • Fax: 301-856-5454
Mailing address:
  • Phone: 301-856-5444
  • Fax: 301-856-5454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberD0047748
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License NumberD0047748
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: