Provider Demographics
NPI:1952457665
Name:NACCACHE, MAURICE FOUAD (MD)
Entity Type:Individual
Prefix:DR
First Name:MAURICE
Middle Name:FOUAD
Last Name:NACCACHE
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 1:6201 RIVERDALE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-2150
Mailing Address - Country:US
Mailing Address - Phone:301-277-7371
Mailing Address - Fax:301-277-7789
Practice Address - Street 1:6201 RIVERDALE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-2150
Practice Address - Country:US
Practice Address - Phone:301-277-7371
Practice Address - Fax:301-277-7789
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDO016204261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care