Provider Demographics
NPI:1790736676
Name:FARAMARZ H GHAZI MD PA
Entity Type:Organization
Organization Name:FARAMARZ H GHAZI MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FARAMARZ
Authorized Official - Middle Name:H
Authorized Official - Last Name:GHAZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-549-0777
Mailing Address - Street 1:PO BOX 735
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33780-0735
Mailing Address - Country:US
Mailing Address - Phone:727-549-0777
Mailing Address - Fax:727-549-0998
Practice Address - Street 1:8730 49TH ST
Practice Address - Street 2:SUITE # 14
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33782-5348
Practice Address - Country:US
Practice Address - Phone:727-549-0777
Practice Address - Fax:727-549-0998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0044247261Q00000X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL36392Medicare ID - Type Unspecified