Provider Demographics
NPI:1760410856
Name:FARID, TOURAJ (MD)
Entity Type:Individual
Prefix:DR
First Name:TOURAJ
Middle Name:
Last Name:FARID
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 1:1844 HARPER RD
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-3366
Mailing Address - Country:US
Mailing Address - Phone:304-250-0307
Mailing Address - Fax:304-250-0384
Practice Address - Street 1:1844 HARPER RD
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-3366
Practice Address - Country:US
Practice Address - Phone:304-250-0307
Practice Address - Fax:304-250-0384
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV207RG0100X207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001796158OtherBCBS
WV0071981000Medicaid
WV0071981000Medicaid
WV0625356Medicare PIN