Healthcare Provider Details

I. General information

NPI: 1336403963
Provider Name (Legal Business Name): JAMIE ZAKKAK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2012
Last Update Date: 10/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W 7TH ST PEDIATRIC DEPARTMENT
FREDERICK MD
21701-4506
US

IV. Provider business mailing address

400 W 7TH ST PEDIATRIC DEPARTMENT
FREDERICK MD
21701-4506
US

V. Phone/Fax

Practice location:
  • Phone: 240-566-3470
  • Fax: 240-566-3966
Mailing address:
  • Phone: 240-566-3470
  • Fax: 240-566-3966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0116025149
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0079614
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: