Provider Demographics
NPI:1659393304
Name:LARI, FAYE MOUL (MD)
Entity Type:Individual
Prefix:
First Name:FAYE
Middle Name:MOUL
Last Name:LARI
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 1:3706 GREEN OAK CT
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234
Mailing Address - Country:US
Mailing Address - Phone:410-241-6749
Mailing Address - Fax:410-328-5882
Practice Address - Street 1:FAMILY HEALTH AND WELLNESS
Practice Address - Street 2:69 WOLF ACRES LOWER LEVEL
Practice Address - City:OAKLAND
Practice Address - State:MD
Practice Address - Zip Code:21550-2046
Practice Address - Country:US
Practice Address - Phone:301-533-2190
Practice Address - Fax:410-328-5882
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00467242084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD843700900Medicaid
MD996TMedicare PIN