Provider Demographics
NPI:1114245800
Name:FAM, ANTHONY FARID (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:FARID
Last Name:FAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1199 PACIFIC HWY UNIT 1606
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-8419
Mailing Address - Country:US
Mailing Address - Phone:559-579-8343
Mailing Address - Fax:619-373-9206
Practice Address - Street 1:1199 PACIFIC HWY UNIT 1606
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-8419
Practice Address - Country:US
Practice Address - Phone:559-579-8343
Practice Address - Fax:619-373-9206
Is Sole Proprietor?:No
Enumeration Date:2010-05-06
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116023029207R00000X
VA0101254861207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine