Provider Demographics
NPI:1376551937
Name:HAKIM, ESMET A (MD)
Entity Type:Individual
Prefix:
First Name:ESMET
Middle Name:A
Last Name:HAKIM
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 1:110 WINN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-2897
Mailing Address - Country:US
Mailing Address - Phone:781-933-3734
Mailing Address - Fax:781-932-3278
Practice Address - Street 1:2 REHABILITATION WAY
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-6003
Practice Address - Country:US
Practice Address - Phone:781-935-5050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA050613207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA050613OtherTUFTS HEALTH PLAN
MA3104486Medicaid
MA691035OtherHARVARD PILGRIM
MAJ13493OtherBLUE CROSS/BLUE SHIELD
MA050613OtherTUFTS HEALTH PLAN
MAJ13493Medicare ID - Type Unspecified