Provider Demographics
NPI:1346380896
Name:HAWIT, FARIS (MD)
Entity Type:Individual
Prefix:DR
First Name:FARIS
Middle Name:
Last Name:HAWIT
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:PO BOX 1540
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-1540
Mailing Address - Country:US
Mailing Address - Phone:410-535-4561
Mailing Address - Fax:866-397-4120
Practice Address - Street 1:130 HOSPITAL RD
Practice Address - Street 2:STE 200
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-4015
Practice Address - Country:US
Practice Address - Phone:410-535-4561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD61859207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD412713700Medicaid
MD412713700Medicaid