Provider Demographics
NPI:1346203767
Name:MIAN, FARHAT S (MD)
Entity Type:Individual
Prefix:DR
First Name:FARHAT
Middle Name:S
Last Name:MIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2335 CHESTERFIELD AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1066
Mailing Address - Country:US
Mailing Address - Phone:304-343-6199
Mailing Address - Fax:304-343-6299
Practice Address - Street 1:2335 CHESTERFIELD AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1062
Practice Address - Country:US
Practice Address - Phone:304-343-6199
Practice Address - Fax:304-343-6299
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV17517207ZP0102X
KY31574207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64940950Medicaid
WV0103190000Medicaid
WVG22088Medicare UPIN
WV0797321Medicare ID - Type Unspecified