Provider Demographics
NPI:1437358900
Name:FARIDI, OMAR S (MD)
Entity Type:Individual
Prefix:
First Name:OMAR
Middle Name:S
Last Name:FARIDI
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 1:202 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-3502
Mailing Address - Country:US
Mailing Address - Phone:203-878-1236
Mailing Address - Fax:203-874-8838
Practice Address - Street 1:202 CHERRY ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-3502
Practice Address - Country:US
Practice Address - Phone:203-878-1236
Practice Address - Fax:203-874-8838
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT050495207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004068649Medicaid