Healthcare Provider Details

I. General information

NPI: 1215933221
Provider Name (Legal Business Name): DAVID J HAIDAK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 05/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8926 WOODYARD RD STE 201
CLINTON MD
20735-4231
US

IV. Provider business mailing address

8926 WOODYARD RD STE 201
CLINTON MD
20735-4231
US

V. Phone/Fax

Practice location:
  • Phone: 301-868-7911
  • Fax: 301-868-2285
Mailing address:
  • Phone: 301-868-7911
  • Fax: 301-868-2285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberD0017605
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: