Basic Information
| Provider Information | |||||||||
| NPI: | 1649224551 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAKKI | ||||||||
| FirstName: | FAWAZ | ||||||||
| MiddleName: | ZAKAI | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 785 5TH AVENUE | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172014232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172639555 | ||||||||
| FaxNumber: | 7172174218 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | WAYNESBORO | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172682353 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177653648 | ||||||||
| FaxNumber: | 7177653647 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2006 | ||||||||
| LastUpdateDate: | 10/31/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD429143 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RI0008X | MD429143 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hepatology | 207RG0100X | MD429143 | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 25-1716306 | 01 | PA | INTERGROUP | OTHER | 50062744 | 01 | PA | CAPITAL BLUECROSS | OTHER | 7514222 | 01 | PA | AETNA NON-HMO | OTHER | P00377937 | 01 | PA | RAILROAD MEDICARE | OTHER | 101713873 0002 | 05 | PA | MEDICAID | 1559922 | 01 | PA | GATEWAY | OTHER | 2165768 | 01 | PA | MAMSI | OTHER | 25-1716306 | 01 | PA | DEVON | OTHER | 458610 | 01 | PA | HEALTH AMERICA | OTHER | 193600 | 01 | PA | UNISON | OTHER | 25-1716306 | 01 | PA | SOUTH CENTRAL PREFERRED | OTHER | 25-1716306 | 01 | PA | FIRST HEALTH | OTHER | 867633 | 01 | PA | MEDICARE GROUP # | OTHER | BH9923942 | 01 | PA | DEA | OTHER | G920-0064/KDM4CU | 01 | PA | CAREFIRST | OTHER | 1373348 | 01 | PA | AETNA HMO | OTHER | 25-1716306 | 01 | PA | GREATWEST | OTHER | 25-1716306 | 01 | PA | MULTIPLAN/PHCS | OTHER | 25-1716306 | 01 | PA | INFORMED | OTHER | HA1886704 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 25-1716306 | 01 | PA | HEALTHNET/TRICARE | OTHER | MD429143 | 01 | PA | LICENSE | OTHER |