Provider Demographics
NPI:1760426068
Name:FARIDI, AHMAD B (MD)
Entity Type:Individual
Prefix:
First Name:AHMAD
Middle Name:B
Last Name:FARIDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:300 PROSPERITY LN
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LOGAN
Mailing Address - State:WV
Mailing Address - Zip Code:25601-3743
Mailing Address - Country:US
Mailing Address - Phone:304-752-8800
Mailing Address - Fax:304-752-9000
Practice Address - Street 1:300 PROSPERITY LANE
Practice Address - Street 2:SUITE 203
Practice Address - City:LOGAN
Practice Address - State:WV
Practice Address - Zip Code:25601
Practice Address - Country:US
Practice Address - Phone:304-752-8800
Practice Address - Fax:304-758-9000
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2021-01-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY42343207RN0300X
WV22245207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100168950Medicaid
KYK10756Medicare PIN
WVFA4184692Medicare PIN
I25999Medicare UPIN