Provider Demographics
NPI:1801418629
Name:FARAZ MASOOD PLLC
Entity Type:Organization
Organization Name:FARAZ MASOOD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FARAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:MASOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:660-868-2684
Mailing Address - Street 1:16021 KAIROS RD STE A
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23834-5208
Mailing Address - Country:US
Mailing Address - Phone:804-526-6065
Mailing Address - Fax:804-526-6065
Practice Address - Street 1:16021 KAIROS RD STE A
Practice Address - Street 2:
Practice Address - City:SOUTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23834-5208
Practice Address - Country:US
Practice Address - Phone:804-526-6065
Practice Address - Fax:804-526-6065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-14
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care