Provider Demographics
NPI:1285685834
Name:FAROOQI, IKRAM A (MD CWS)
Entity Type:Individual
Prefix:
First Name:IKRAM
Middle Name:A
Last Name:FAROOQI
Suffix:
Gender:M
Credentials:MD CWS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 WALNUT ST
Mailing Address - Street 2:SUITE 360
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-2118
Mailing Address - Country:US
Mailing Address - Phone:781-898-7301
Mailing Address - Fax:781-898-7302
Practice Address - Street 1:65 WALNUT ST
Practice Address - Street 2:SUITE 360
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-2118
Practice Address - Country:US
Practice Address - Phone:781-898-7301
Practice Address - Fax:781-898-7302
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA158637207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3600203OtherAETNA
MA463963OtherTUFTS
MA110060955AMedicaid
MAJ19902OtherBCBS
MA0027018OtherNEIGHBORHOOD HEALTH
MA0407604OtherEVERCARE
MA3643404OtherCIGNA
MAAA7118OtherHARVARD PILGRIM
MAJ19902OtherBCBS
MAA29217Medicare ID - Type Unspecified