Provider Demographics
NPI:1730134602
Name:SULTANI, FAROUK A (MD)
Entity Type:Individual
Prefix:DR
First Name:FAROUK
Middle Name:A
Last Name:SULTANI
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 1:314 W CARROLL ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-5305
Mailing Address - Country:US
Mailing Address - Phone:410-546-0464
Mailing Address - Fax:410-546-8529
Practice Address - Street 1:314 W CARROLL ST
Practice Address - Street 2:SUITE 1
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-5305
Practice Address - Country:US
Practice Address - Phone:410-546-0464
Practice Address - Fax:410-546-8529
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00277792082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD82732Medicare UPIN
MDK119Medicare ID - Type UnspecifiedMEDICARE