Provider Demographics
NPI:1780826743
Name:TARIQ-FAZILI, AFREEN (MD)
Entity Type:Individual
Prefix:
First Name:AFREEN
Middle Name:
Last Name:TARIQ-FAZILI
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 1:2337 RIDGEWAY AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-4111
Mailing Address - Country:US
Mailing Address - Phone:585-225-6680
Mailing Address - Fax:585-225-3472
Practice Address - Street 1:2337 RIDGEWAY AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626
Practice Address - Country:US
Practice Address - Phone:585-225-6680
Practice Address - Fax:585-225-3472
Is Sole Proprietor?:No
Enumeration Date:2009-04-06
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY270747207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology