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General NPI Number Information
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NPI Number | 1336403963
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Entity Type | Individual
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Provider Name | JAMIE ZAKKAK M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/28/2012
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Last Update Date | 10/18/2015
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Provider Practice Location Address
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Address Line | 400 W 7TH ST PEDIATRIC DEPARTMENT
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City | FREDERICK
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State | MD
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Zip | 21701-4506
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Country | US
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Telephone | 240-566-3470
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Fax | 240-566-3966
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Provider Business Mailing Address
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Address Line | 400 W 7TH ST PEDIATRIC DEPARTMENT
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City | FREDERICK
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State | MD
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Zip | 21701-4506
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Country | US
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Telephone | 240-566-3470
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Fax | 240-566-3966
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 0116025149
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | D0079614
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License Number State | MD
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