1689810384 NPI number — FARIBA SHAH MD

Table of content: FARIBA SHAH MD (NPI 1689810384)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689810384 NPI number — FARIBA SHAH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHAH
Provider First Name:
FARIBA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
EMAMHOSSEINI
Provider Other First Name:
FARIBA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1689810384
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/11/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18109 PRINCE PHILIP DR
Provider Second Line Business Mailing Address:
SUITE 155
Provider Business Mailing Address City Name:
OLNEY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20832-1519
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-570-7415
Provider Business Mailing Address Fax Number:
301-570-7416

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18109 PRINCE PHILIP DR
Provider Second Line Business Practice Location Address:
SUITE 155
Provider Business Practice Location Address City Name:
OLNEY
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20832-1519
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-570-7415
Provider Business Practice Location Address Fax Number:
301-570-7416
Provider Enumeration Date:
12/30/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , with the licence number:  D73443 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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