Provider Demographics
NPI:1710028642
Name:FAKHRY, CAROLE (MD)
Entity Type:Individual
Prefix:
First Name:CAROLE
Middle Name:
Last Name:FAKHRY
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 1:601 N. CAROLILNE ST, 6TH FLOOR
Mailing Address - Street 2:DEPARTMENT OTOLOARGYOLOGY HEAD AND NECK SURGERY
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21287
Mailing Address - Country:US
Mailing Address - Phone:410-955-6420
Mailing Address - Fax:
Practice Address - Street 1:601 N. CAROLINE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287
Practice Address - Country:US
Practice Address - Phone:443-287-2024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0070690207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD036686200Medicaid
MD036686200Medicaid
MD192119ZAK8Medicare PIN