Provider Demographics
NPI:1154393213
Name:HACKETT, FAITH ALICE (MD)
Entity type:Individual
Prefix:
First Name:FAITH
Middle Name:ALICE
Last Name:HACKETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:844 RITCHIE HWY
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146
Mailing Address - Country:US
Mailing Address - Phone:410-647-8300
Mailing Address - Fax:410-315-8444
Practice Address - Street 1:844 RITCHIE HWY
Practice Address - Street 2:SUITE 206
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146
Practice Address - Country:US
Practice Address - Phone:410-647-8300
Practice Address - Fax:410-315-8444
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD32426208000000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Not Answered2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
03794OtherAMERICAID
MD0H64OtherCBCBS
11120OtherBS POS
OH64OtherBS
0553696119OtherUHC HMO
06704OtherPHN
726556OtherUS AETNA (HMO)
811265OtherMD/OP/ALLIANCE
T593001OtherBLUE CHOICE
4077FAOtherMC
38000OtherEHP
38000OtherPRIORITY
4338237OtherAETNA
T5930001OtherBSFED
MD38000OtherJHEHP
38000OtherPRIORITY