Provider Demographics
NPI:1285648329
Name:FARAG, SAMIR F (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMIR
Middle Name:F
Last Name:FARAG
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:PO BOX 432
Mailing Address - Street 2:
Mailing Address - City:GWYNEDD VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19437-0432
Mailing Address - Country:US
Mailing Address - Phone:610-489-3333
Mailing Address - Fax:610-489-9390
Practice Address - Street 1:3774 RIDGE PIKE
Practice Address - Street 2:SUITE 101
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426-3169
Practice Address - Country:US
Practice Address - Phone:610-489-3333
Practice Address - Fax:610-489-9390
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039341L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA09727980112Medicaid
138143Medicare ID - Type Unspecified
PA09727980112Medicaid