Provider Demographics
NPI:1386107290
Name:HALLAK, ERIKA (DO)
Entity type:Individual
Prefix:
First Name:ERIKA
Middle Name:
Last Name:HALLAK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:FAMILY HEALTH CLINIC ATTN: DR. ERIKA HALLAK
Mailing Address - Street 2:1060 WEST PERIMETER RD.
Mailing Address - City:JOINT BASE ANDREWS
Mailing Address - State:MD
Mailing Address - Zip Code:20762
Mailing Address - Country:US
Mailing Address - Phone:240-612-1240
Mailing Address - Fax:
Practice Address - Street 1:FAMILY HEALTH CLINIC ATTN: DR. ERIKA HALLAK
Practice Address - Street 2:1060 WEST PERIMETER RD.
Practice Address - City:JOINT BASE ANDREWS
Practice Address - State:MD
Practice Address - Zip Code:20762
Practice Address - Country:US
Practice Address - Phone:240-612-1240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-08
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2244207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program