Provider Demographics
NPI:1467449074
Name:MONFARED, ZIBA RAHJOI (MD)
Entity Type:Individual
Prefix:DR
First Name:ZIBA
Middle Name:RAHJOI
Last Name:MONFARED
Suffix:
Gender:F
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:PO BOX 758952
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21275-8952
Mailing Address - Country:US
Mailing Address - Phone:804-968-5700
Mailing Address - Fax:
Practice Address - Street 1:2450 BUTLER ST
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-5303
Practice Address - Country:US
Practice Address - Phone:610-991-3136
Practice Address - Fax:610-991-3137
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD425165207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P006796OtherGATEWAY
2353688000OtherIBC
1679717OtherHIGHMARK BLUE SHIELD
1679717OtherHIGHMARK BLUE SHIELD
PA311498Medicare PIN
PA088084NTBMedicare PIN
50050268OtherCBC
2353688000OtherIBC