Provider Demographics
NPI:1992859102
Name:AYUBI, FARHAN SHOAIB (DO)
Entity Type:Individual
Prefix:DR
First Name:FARHAN
Middle Name:SHOAIB
Last Name:AYUBI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W HOSPITAL RD
Mailing Address - Street 2:EISENHOWER ARMY MEDICAL CENTER
Mailing Address - City:FORT GORDON
Mailing Address - State:GA
Mailing Address - Zip Code:30905-5741
Mailing Address - Country:US
Mailing Address - Phone:706-787-2720
Mailing Address - Fax:706-787-8176
Practice Address - Street 1:4494 PALMER RD N
Practice Address - Street 2:WRNMMC
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20815-5741
Practice Address - Country:US
Practice Address - Phone:808-798-6776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY60 240073208600000X
HIDOS-15552086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD 000Medicare UPIN