Provider Demographics
NPI:1316008683
Name:SADEGHI, FARIDEH (MD)
Entity Type:Individual
Prefix:DR
First Name:FARIDEH
Middle Name:
Last Name:SADEGHI
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:KAISER PERMANENTE MID ATLANTIC PERMANENTE MEDICAL GROUP
Mailing Address - Street 2:2101 EAST JEFFERSON STREET PPQA MEDICARE COMP UNIT 6
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4908
Mailing Address - Country:US
Mailing Address - Phone:301-816-6660
Mailing Address - Fax:601-816-6308
Practice Address - Street 1:3300 GALLOWS ROAD
Practice Address - Street 2:KAISER HSM OFFICE
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-4518
Practice Address - Country:US
Practice Address - Phone:703-776-3591
Practice Address - Fax:703-776-6593
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101046868207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
010330M92Medicare ID - Type Unspecified
F43915Medicare UPIN