Provider Demographics
NPI:1700866472
Name:JAFRI, FARRUKH M (MD)
Entity Type:Individual
Prefix:
First Name:FARRUKH
Middle Name:M
Last Name:JAFRI
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:PO BOX 745462
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-5462
Mailing Address - Country:US
Mailing Address - Phone:540-370-0430
Mailing Address - Fax:540-370-0021
Practice Address - Street 1:1500 DIXON ST STE 202
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-7231
Practice Address - Country:US
Practice Address - Phone:540-370-0430
Practice Address - Fax:540-370-0021
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101236985207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA3130173OtherMAMSI
VA0101236985OtherLICENSE
VA7404613OtherAETNA NON HMO
VACA9037OtherMCR RAILROAD GROUP
VA3643935OtherAETNA HMO
VACO2375OtherMEDICARE GROUP
VA010106141Medicaid
VA170342OtherANTHEM
VA170342OtherANTHEM
VA010106141Medicaid
VA005980P75Medicare PIN