Provider Demographics
NPI:1700854619
Name:FARAH, ZIAD G (MD)
Entity Type:Individual
Prefix:
First Name:ZIAD
Middle Name:G
Last Name:FARAH
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 1:525 LONG POND DR
Mailing Address - Street 2:FONTAINE MEDICAL CENTER
Mailing Address - City:HARWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02645
Mailing Address - Country:US
Mailing Address - Phone:508-432-4100
Mailing Address - Fax:508-432-8951
Practice Address - Street 1:525 LONG POND DR
Practice Address - Street 2:FONTAINE MEDICAL CENTER
Practice Address - City:HARWICH
Practice Address - State:MA
Practice Address - Zip Code:02645
Practice Address - Country:US
Practice Address - Phone:508-432-4100
Practice Address - Fax:508-432-8951
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA51990207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3015769Medicaid
MA61647OtherHPHC
MAJ06037OtherBCBS
MA3015769Medicaid
MAJ06037OtherBCBS