Provider Demographics
NPI:1760819304
Name:FARHADFAR, NOSHA (MD)
Entity Type:Individual
Prefix:MRS
First Name:NOSHA
Middle Name:
Last Name:FARHADFAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4450 MEDICAL DR FL 1
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3710
Mailing Address - Country:US
Mailing Address - Phone:210-575-3817
Mailing Address - Fax:210-575-4113
Practice Address - Street 1:4450 MEDICAL DR FL 1
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3710
Practice Address - Country:US
Practice Address - Phone:210-575-3817
Practice Address - Fax:210-575-4113
Is Sole Proprietor?:No
Enumeration Date:2013-09-27
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME128403207RX0202X, 207RH0000X
NY39020000X390200000X
TXU5100207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018589600Medicaid
FL018589600Medicaid