Provider Demographics
NPI:1093855900
Name:IRSHAD, FARID A (PA)
Entity Type:Individual
Prefix:
First Name:FARID
Middle Name:A
Last Name:IRSHAD
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3353 MENDON RD STE 3
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-2122
Mailing Address - Country:US
Mailing Address - Phone:401-405-0899
Mailing Address - Fax:401-405-0890
Practice Address - Street 1:3353 MENDON RD STE 3
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:RI
Practice Address - Zip Code:02864
Practice Address - Country:US
Practice Address - Phone:401-405-0899
Practice Address - Fax:401-405-0890
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIPA00420363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI979005437Medicare PIN