Provider Demographics
NPI:1376516211
Name:HACKNEY, DAVID N (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:N
Last Name:HACKNEY
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 1:24701 EUCLID AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-844-3941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.083363207VG0400X, 207VM0101X
NY250093207VG0400X, 207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000933940001OtherHEALTHNOW
NY0553621OtherGHI
OH0070338Medicaid
NY080923000132OtherFIDELIS
NY1376516211OtherEXCELLUS
NY1376516211OtherPREFERRED CARE/ MVP
NY1376516211OtherUNIVERA
OH35.083363OtherLICENSE
OH0070338Medicaid
NYJ400042906Medicare PIN
NY080923000132OtherFIDELIS
NYJ400001690Medicare PIN
NYJ400002276Medicare PIN