Provider Demographics
NPI:1053488502
Name:FAKADEJ, MARIA (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:FAKADEJ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4117 N ROXBORO ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-2121
Mailing Address - Country:US
Mailing Address - Phone:919-684-8111
Mailing Address - Fax:
Practice Address - Street 1:11618 US HIGHWAY 70 W
Practice Address - Street 2:SUITE 200
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-2275
Practice Address - Country:US
Practice Address - Phone:919-550-6133
Practice Address - Fax:919-550-1802
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2013-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2000-00052207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891251LMedicaid
H10528Medicare UPIN
NC2280123Medicare PIN