Provider Demographics
NPI:1861401903
Name:HACK, DAVID WALTER (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:WALTER
Last Name:HACK
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:PO BOX 824804
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-4804
Mailing Address - Country:US
Mailing Address - Phone:302-575-8040
Mailing Address - Fax:302-575-8005
Practice Address - Street 1:701 N CLAYTON ST
Practice Address - Street 2:MSB SUITE 200
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-3165
Practice Address - Country:US
Practice Address - Phone:302-575-8040
Practice Address - Fax:302-575-8005
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10005593207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000999301Medicaid
P00096976OtherRR MEDICARE
577489OtherAETNA USHC
9046OtherCOVENTRY
0415435000OtherAMERIHEALTH
DE0000999301Medicaid
H04175Medicare UPIN
H04175Medicare UPIN
DE501490Medicare PIN