Provider Demographics
NPI:1285030528
Name:TRI-CITIES GERIATRICS, PC
Entity Type:Organization
Organization Name:TRI-CITIES GERIATRICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:FAROOQ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-721-9148
Mailing Address - Street 1:1714 E HUNDRED RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23836-3310
Mailing Address - Country:US
Mailing Address - Phone:804-721-9148
Mailing Address - Fax:804-530-5295
Practice Address - Street 1:1714 E HUNDRED RD
Practice Address - Street 2:SUITE 101
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23836-3310
Practice Address - Country:US
Practice Address - Phone:804-721-9148
Practice Address - Fax:804-530-5295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-14
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101055927207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty