Provider Demographics
NPI:1336307032
Name:FAITH HACKETT, M.D.
Entity Type:Organization
Organization Name:FAITH HACKETT, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FAITH
Authorized Official - Middle Name:ALICE
Authorized Official - Last Name:HACKETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-647-8300
Mailing Address - Street 1:844 RITCHIE HWY
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-4127
Mailing Address - Country:US
Mailing Address - Phone:410-647-8300
Mailing Address - Fax:410-315-8444
Practice Address - Street 1:844 RITCHIE HWY
Practice Address - Street 2:SUITE 206
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-4127
Practice Address - Country:US
Practice Address - Phone:410-647-8300
Practice Address - Fax:410-315-8444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD324262080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD408221400Medicaid