Provider Demographics
NPI:1851390983
Name:FARHANGI, VIDA (MD)
Entity Type:Individual
Prefix:DR
First Name:VIDA
Middle Name:
Last Name:FARHANGI
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:PO BOX 863407
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32886-3407
Mailing Address - Country:US
Mailing Address - Phone:941-917-2600
Mailing Address - Fax:941-917-7884
Practice Address - Street 1:1825 DR MARTIN LUTHER KING WAY
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34234-2525
Practice Address - Country:US
Practice Address - Phone:941-952-4123
Practice Address - Fax:941-952-4101
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 103260207R00000X
OH35-07-8961F207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7486229OtherAETNA
OH000000233015OtherANTHEM & BLUE CROSS
FL1407806094OtherGROUP NPI
FL20-1841070OtherPRACTICE TAX ID
4043245OtherMEDICARE
OHP00121471OtherRAILROAD MEDICARE
OH76-00115OtherUNITED HEALTH CARE
OH2232873Medicaid
OH6199428002OtherCIGNA
OHD-78961OtherHUMANA
4043245OtherMEDICARE