Provider Demographics
NPI:1891722419
Name:FAROOQ, FAHEEM M (MD)
Entity Type:Individual
Prefix:
First Name:FAHEEM
Middle Name:M
Last Name:FAROOQ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:124 GROVE STREET
Mailing Address - Street 2:STE 305
Mailing Address - City:FRANKLIN
Mailing Address - State:MA
Mailing Address - Zip Code:02038-3156
Mailing Address - Country:US
Mailing Address - Phone:508-528-5392
Mailing Address - Fax:508-541-2420
Practice Address - Street 1:100 MEDWAY ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-3003
Practice Address - Country:US
Practice Address - Phone:508-773-6288
Practice Address - Fax:508-482-5430
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2010-12-15
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Provider Licenses
StateLicense IDTaxonomies
MA41365207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2055821Medicaid
A55086Medicare UPIN
MABX8903Medicare UPIN
MA2055821Medicaid