Provider Demographics
NPI:1710176763
Name:NASEH, FARHAD (MD)
Entity Type:Individual
Prefix:DR
First Name:FARHAD
Middle Name:
Last Name:NASEH
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 1:6 MONTGOMERY VILLAGE AVE
Mailing Address - Street 2:103
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-3546
Mailing Address - Country:US
Mailing Address - Phone:301-840-2208
Mailing Address - Fax:301-840-2210
Practice Address - Street 1:6 MONTGOMERY VILLAGE AVE
Practice Address - Street 2:103
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-3546
Practice Address - Country:US
Practice Address - Phone:301-840-2208
Practice Address - Fax:301-840-2210
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-16
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0050523174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD682700400Medicaid
G02199OtherMEDICARE ID
MDG02199F01OtherMEDICARE INDIVIDUAL #
MD6179780001Medicare NSC
MD682700400Medicaid