Basic Information
| Provider Information | |||||||||
| NPI: | 1932113446 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAKIM | ||||||||
| FirstName: | FAIYAZ | ||||||||
| MiddleName: | H | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 290 TURNPIKE RD STE 150-414 | ||||||||
| Address2: | |||||||||
| City: | WESTBOROUGH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 015812843 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087534151 | ||||||||
| FaxNumber: | 5087511974 | ||||||||
| Practice Location | |||||||||
| Address1: | 290 TURNPIKE RD STE 150-414 | ||||||||
| Address2: | |||||||||
| City: | WESTBOROUGH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 015812843 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087534151 | ||||||||
| FaxNumber: | 5087511974 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2006 | ||||||||
| LastUpdateDate: | 10/15/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 10/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 75082 | MA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207R00000X | 75082 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3090922 | 05 | MA | MEDICAID |