Provider Demographics
NPI:1356739098
Name:JOHN P. HAKIM, MD AND ASSOCIATES
Entity type:Organization
Organization Name:JOHN P. HAKIM, MD AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSCIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PIERRE
Authorized Official - Last Name:HAKIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-880-5146
Mailing Address - Street 1:3195 LACROSSE CT
Mailing Address - Street 2:
Mailing Address - City:DUNKIRK
Mailing Address - State:MD
Mailing Address - Zip Code:20754-2926
Mailing Address - Country:US
Mailing Address - Phone:443-880-5146
Mailing Address - Fax:301-856-5444
Practice Address - Street 1:7700 OLD BRANCH AVE
Practice Address - Street 2:SUITE E105
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-1628
Practice Address - Country:US
Practice Address - Phone:301-856-5444
Practice Address - Fax:301-856-5454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-05
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD47748207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD407211100Medicaid
VA01010324009Medicaid
DC03770330Medicaid
159626OtherMEDICARE PTAN
VA01010324009Medicaid
159626OtherMEDICARE PTAN