Provider Demographics
NPI:1326103227
Name:SARFARAZI, MOHAMMAD (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:
Last Name:SARFARAZI
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 1:6011 KIRBY RD
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-6247
Mailing Address - Country:US
Mailing Address - Phone:301-365-5809
Mailing Address - Fax:301-365-5813
Practice Address - Street 1:7525 GREENWAY CENTER DR STE 309
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770
Practice Address - Country:US
Practice Address - Phone:301-345-4465
Practice Address - Fax:301-345-7797
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0048042207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD354BMOtherCAREFIRST OF MARYLAND INC
DCK1650001OtherGHMSI AND BLUECHOICE
MD097000000Medicaid
DCK1650001OtherGHMSI AND BLUECHOICE
DCP00192310Medicare PIN
MD354BMOtherCAREFIRST OF MARYLAND INC