Provider Demographics
NPI:1346299971
Name:PARACHA, FAISAL WAHEED (MD)
Entity Type:Individual
Prefix:
First Name:FAISAL
Middle Name:WAHEED
Last Name:PARACHA
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 1:1240 ULSTER AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-1517
Mailing Address - Country:US
Mailing Address - Phone:845-443-8721
Mailing Address - Fax:845-790-3182
Practice Address - Street 1:1240 ULSTER AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-1517
Practice Address - Country:US
Practice Address - Phone:845-443-8721
Practice Address - Fax:845-790-3182
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY255357174400000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02756485Medicaid
2Z6582L811Medicare PIN
NY02756485Medicaid