Provider Demographics
NPI:1417953761
Name:SHOLEVAR, FARHAD (MD)
Entity Type:Individual
Prefix:DR
First Name:FARHAD
Middle Name:
Last Name:SHOLEVAR
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 1:2895 HAMILTON BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-6172
Mailing Address - Country:US
Mailing Address - Phone:610-435-8986
Mailing Address - Fax:610-435-8307
Practice Address - Street 1:2895 HAMILTON BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-6172
Practice Address - Country:US
Practice Address - Phone:610-435-8986
Practice Address - Fax:610-435-8307
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-040068-Y2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1149389 0006Medicaid
PA1149389 0006Medicaid
PA137239TBSMedicare PIN
PA084525Medicare ID - Type UnspecifiedMEDICARE GROUP #