Provider Demographics
NPI:1104866441
Name:FAROOQ, SABAHAT (MD)
Entity Type:Individual
Prefix:DR
First Name:SABAHAT
Middle Name:
Last Name:FAROOQ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3034 KNIGHTS ROAD
Mailing Address - Street 2:KNIGHTS MEDICAL ROAD
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020
Mailing Address - Country:US
Mailing Address - Phone:215-638-7400
Mailing Address - Fax:215-244-6524
Practice Address - Street 1:3034 KNIGHTS ROAD
Practice Address - Street 2:KNIGHTS MEDICAL ROAD
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020
Practice Address - Country:US
Practice Address - Phone:215-638-7400
Practice Address - Fax:215-244-6524
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-069069-L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01692663Medicaid
PA01692663Medicaid
PA022653Medicare ID - Type Unspecified