Provider Demographics
NPI:1790710358
Name:FARAG, ATIF (MD)
Entity Type:Individual
Prefix:
First Name:ATIF
Middle Name:
Last Name:FARAG
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 1:3945 S ATHERTON ST
Mailing Address - Street 2:STE A
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-8308
Mailing Address - Country:US
Mailing Address - Phone:814-235-3898
Mailing Address - Fax:814-235-3899
Practice Address - Street 1:1800 E PARK AVE
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803-6701
Practice Address - Country:US
Practice Address - Phone:814-231-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD070335L207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50020159OtherKEYSTONE HEALTH PLAN CENT
PA50020159OtherCAPITAL BLUE CROSS
PA738002OtherHIGHMARK BLUE SHIELD
PA57757OtherGEISINGER HEALTH PLAN
PAP00019734OtherRAILROAD MEDICARE
PA0017954640002Medicaid
PA50020159OtherKEYSTONE HEALTH PLAN CENT
PA50020159OtherCAPITAL BLUE CROSS