Provider Demographics
NPI:1033295688
Name:FARAZDAGHI, MOHAMMAD SADEGH (DC)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:SADEGH
Last Name:FARAZDAGHI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 E 25TH ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-5142
Mailing Address - Country:US
Mailing Address - Phone:410-235-6280
Mailing Address - Fax:410-235-6281
Practice Address - Street 1:22 E 25TH ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-5142
Practice Address - Country:US
Practice Address - Phone:410-235-6280
Practice Address - Fax:410-235-6281
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03399111N00000X
MDS03399111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG01600M01Medicare UPIN