Provider Demographics
NPI:1366827800
Name:GULAID, FARAH
Entity Type:Individual
Prefix:
First Name:FARAH
Middle Name:
Last Name:GULAID
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 BOSTON ST
Mailing Address - Street 2:STE 106
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-4723
Mailing Address - Country:US
Mailing Address - Phone:410-675-0434
Mailing Address - Fax:
Practice Address - Street 1:2400 BOSTON STREET
Practice Address - Street 2:SUITE 106
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224
Practice Address - Country:US
Practice Address - Phone:410-675-0434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-27
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA2484152W00000X
GAOPT002961152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDTA2484OtherMARYLAND LICENSE