Provider Demographics
NPI:1629025630
Name:FARHA, MAEN J (MD)
Entity Type:Individual
Prefix:
First Name:MAEN
Middle Name:J
Last Name:FARHA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3333 N CALVERT ST
Mailing Address - Street 2:SUITE 655
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-2867
Mailing Address - Country:US
Mailing Address - Phone:410-321-8720
Mailing Address - Fax:410-321-8723
Practice Address - Street 1:3333 N CALVERT ST
Practice Address - Street 2:SUITE 655
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-2867
Practice Address - Country:US
Practice Address - Phone:410-321-8720
Practice Address - Fax:410-321-8723
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2010-12-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD29771208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD29771OtherSTATE LICENSE
DCE565 0001OtherCAREFIRST
MD649601601 320401400Medicaid
GACH7837 020025381OtherRAILROAD MEDICARE
MDKL92BA 31098504OtherCAREFIRST
MD649601601 320401400Medicaid
MDKL92BA 31098504OtherCAREFIRST