Healthcare Provider Details

I. General information

NPI: 1740454750
Provider Name (Legal Business Name): YAQUB M. BARAKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2008
Last Update Date: 04/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44084 RIVERSIDE PKWY SUITE 230
LANSDOWNE VA
20176-5102
US

IV. Provider business mailing address

10845 PHILADELPHIA RD
WHITE MARSH MD
21162-1717
US

V. Phone/Fax

Practice location:
  • Phone: 703-687-3158
  • Fax: 703-687-3166
Mailing address:
  • Phone: 410-335-0008
  • Fax: 410-335-3113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberD68504
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberD68504
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number0101244834
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0101244834
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: