Provider Demographics
NPI:1033180955
Name:FAKHAR, WASIM (MD)
Entity Type:Individual
Prefix:
First Name:WASIM
Middle Name:
Last Name:FAKHAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 E BALTIMORE ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:TANEYTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21787-2300
Mailing Address - Country:US
Mailing Address - Phone:410-756-2121
Mailing Address - Fax:410-756-2830
Practice Address - Street 1:417 E BALTIMORE ST
Practice Address - Street 2:SUITE D
Practice Address - City:TANEYTOWN
Practice Address - State:MD
Practice Address - Zip Code:21787-2300
Practice Address - Country:US
Practice Address - Phone:410-756-2121
Practice Address - Fax:410-756-2830
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0054580207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD138RMedicare ID - Type Unspecified
MDH01023Medicare UPIN