Provider Demographics
NPI:1457332652
Name:DAKAK, NADER A (MD)
Entity Type:Individual
Prefix:
First Name:NADER
Middle Name:A
Last Name:DAKAK
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 60443
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20859-0443
Mailing Address - Country:US
Mailing Address - Phone:301-805-1250
Mailing Address - Fax:301-805-0795
Practice Address - Street 1:12150 ANNAPOLIS RD
Practice Address - Street 2:SUITE 105
Practice Address - City:GLENN DALE
Practice Address - State:MD
Practice Address - Zip Code:20769-9183
Practice Address - Country:US
Practice Address - Phone:301-805-1250
Practice Address - Fax:301-805-0795
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-07
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0046065207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC022678700OtherDC MEDICAID NUMBER COPY ATTACHED TO FAX
MD271000500Medicaid
DC490182Other855I WAS ISSUED THREE YEARS AGO ON ADDRESS-REISSUING TODAY
DC490182Medicare Oscar/Certification
DC490182Other855I WAS ISSUED THREE YEARS AGO ON ADDRESS-REISSUING TODAY