Provider Demographics
NPI:1770517757
Name:HAKE, GERALD WILLIAM (MD)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:WILLIAM
Last Name:HAKE
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 1:6 EAST WILLIAMSBURG ROAD
Mailing Address - Street 2:
Mailing Address - City:SANDSTON
Mailing Address - State:VA
Mailing Address - Zip Code:23150
Mailing Address - Country:US
Mailing Address - Phone:804-737-1878
Mailing Address - Fax:804-737-0204
Practice Address - Street 1:6 EAST WILLIAMSBURG ROAD
Practice Address - Street 2:
Practice Address - City:SANDSTON
Practice Address - State:VA
Practice Address - Zip Code:23150
Practice Address - Country:US
Practice Address - Phone:804-737-1878
Practice Address - Fax:804-737-0204
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101039097207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA035565OtherANTHEM
B06501Medicare UPIN