Provider Demographics
NPI:1558527242
Name:FARYAN, AZAT
Entity Type:Individual
Prefix:MR
First Name:AZAT
Middle Name:
Last Name:FARYAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 OAKLAND AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-4548
Mailing Address - Country:US
Mailing Address - Phone:401-525-0211
Mailing Address - Fax:
Practice Address - Street 1:36 STAM AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-4439
Practice Address - Country:US
Practice Address - Phone:401-463-6652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-01
Last Update Date:2008-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver