Provider Demographics
NPI:1821402165
Name:HOOKER, DARRYL ANTOINE (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DARRYL
Middle Name:ANTOINE
Last Name:HOOKER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5620 SAINT BARNABAS RD STE 360
Mailing Address - Street 2:
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-3628
Mailing Address - Country:US
Mailing Address - Phone:240-766-4552
Mailing Address - Fax:240-766-4502
Practice Address - Street 1:5620 SAINT BARNABAS RD STE 360
Practice Address - Street 2:
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745
Practice Address - Country:US
Practice Address - Phone:240-766-4552
Practice Address - Fax:240-766-4502
Is Sole Proprietor?:No
Enumeration Date:2014-06-15
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0005314363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD753005600Medicaid