Provider Demographics
NPI:1073962270
Name:SALEH, FARZAD (DPM)
Entity Type:Individual
Prefix:DR
First Name:FARZAD
Middle Name:
Last Name:SALEH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 FIESTA DR
Mailing Address - Street 2:
Mailing Address - City:STEPHENSON
Mailing Address - State:VA
Mailing Address - Zip Code:22656-1876
Mailing Address - Country:US
Mailing Address - Phone:240-285-4270
Mailing Address - Fax:
Practice Address - Street 1:6130 OXON HILL RD STE 305
Practice Address - Street 2:
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-3168
Practice Address - Country:US
Practice Address - Phone:301-567-5005
Practice Address - Fax:301-839-5677
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-08
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01685213ES0103X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program