Provider Demographics
NPI:1740454750
Name:BARAKI, YAQUB M (MD)
Entity type:Individual
Prefix:
First Name:YAQUB
Middle Name:M
Last Name:BARAKI
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 1:10845 PHILADELPHIA RD
Mailing Address - Street 2:
Mailing Address - City:WHITE MARSH
Mailing Address - State:MD
Mailing Address - Zip Code:21162-1717
Mailing Address - Country:US
Mailing Address - Phone:410-335-0008
Mailing Address - Fax:410-335-3113
Practice Address - Street 1:44084 RIVERSIDE PKWY
Practice Address - Street 2:SUITE 230
Practice Address - City:LANSDOWNE
Practice Address - State:VA
Practice Address - Zip Code:20176-5102
Practice Address - Country:US
Practice Address - Phone:703-687-3158
Practice Address - Fax:703-687-3166
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-22
Last Update Date:2017-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD68504208200000X, 208600000X
VA0101244834208200000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDX739 0001OtherCAREFIRST
MD198108YDB5OtherMEDICARE
DCX739 0001OtherCAREFIRST
DC227970YFHZOtherMEDICARE
VAVV6451E050OtherMEDICARE
MD510465300OtherMEDICAL ASSISTANCE