Provider Demographics
NPI:1699941864
Name:WAKED, TAREK (MD)
Entity type:Individual
Prefix:DR
First Name:TAREK
Middle Name:
Last Name:WAKED
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 1:8472 HERRING RUN RD
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19973-5763
Mailing Address - Country:US
Mailing Address - Phone:302-536-5395
Mailing Address - Fax:302-628-3963
Practice Address - Street 1:21635 BIDEN AVE UNIT 203
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:DE
Practice Address - Zip Code:19947-4576
Practice Address - Country:US
Practice Address - Phone:302-260-7360
Practice Address - Fax:302-260-7361
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116019143208600000X
MN55821208600000X
MN106114208600000X
DEC1-0010539208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN020003260Medicare PIN