Provider Demographics
NPI:1073009809
Name:GALIULLIN, FARKHAT
Entity Type:Individual
Prefix:
First Name:FARKHAT
Middle Name:
Last Name:GALIULLIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 HIGHLAND ST
Mailing Address - Street 2:
Mailing Address - City:LACONIA
Mailing Address - State:NH
Mailing Address - Zip Code:03246-3235
Mailing Address - Country:US
Mailing Address - Phone:603-527-2967
Mailing Address - Fax:603-527-2887
Practice Address - Street 1:80 HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:LACONIA
Practice Address - State:NH
Practice Address - Zip Code:03246-3235
Practice Address - Country:US
Practice Address - Phone:603-524-3211
Practice Address - Fax:603-737-6713
Is Sole Proprietor?:No
Enumeration Date:2018-07-04
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH21219207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine