Provider Demographics
NPI:1114168192
Name:LUXXERY CORPORATION OF MARYLAND
Entity Type:Organization
Organization Name:LUXXERY CORPORATION OF MARYLAND
Other - Org Name:LUXXERY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AYMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAKKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-843-9769
Mailing Address - Street 1:3010 CRAIN HIGHWAY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20601
Mailing Address - Country:US
Mailing Address - Phone:301-843-9769
Mailing Address - Fax:301-843-8941
Practice Address - Street 1:3010 CRAIN HWY
Practice Address - Street 2:SUITE 400
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601-2801
Practice Address - Country:US
Practice Address - Phone:301-843-9769
Practice Address - Fax:301-843-8941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-20
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0035306261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4442ARMedicare PIN