Provider Demographics
NPI:1295848497
Name:FARAH, BASSAM (MD)
Entity Type:Individual
Prefix:DR
First Name:BASSAM
Middle Name:
Last Name:FARAH
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 1:1725 FINANCIAL LOOP
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-2903
Mailing Address - Country:US
Mailing Address - Phone:703-492-1108
Mailing Address - Fax:703-492-1109
Practice Address - Street 1:1725 FINANCIAL LOOP
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-2903
Practice Address - Country:US
Practice Address - Phone:703-492-1108
Practice Address - Fax:703-492-1109
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101054538207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA116347OtherANTHEM
5244538OtherAETNA PPO
J7160001OtherCAREFIRST
1205852OtherFIRST HEALTH
2125305OtherALLIANCE
1620011OtherCIGNA
2125305OtherMAMSI ALLIANCE
VA010083371Medicaid
1205852OtherFIRST HEALTH
2125305OtherMAMSI ALLIANCE