Provider Demographics
NPI:1154438497
Name:HATTAR, THOMAS FAHED (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:FAHED
Last Name:HATTAR
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 1:2009 TIDEWATER COLONY DRIVE
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-0000
Mailing Address - Country:US
Mailing Address - Phone:410-224-7615
Mailing Address - Fax:410-224-7240
Practice Address - Street 1:2009 TIDEWATER COLONY DRIVE
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-0000
Practice Address - Country:US
Practice Address - Phone:410-224-7615
Practice Address - Fax:410-224-7240
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0050321207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
251894OtherFEDERAL AVIATION ADMIN
F75183Medicare UPIN
363RMedicare ID - Type Unspecified