Provider Demographics
NPI:1013339290
Name:SULTAN, FARIHA BATOOL (MD)
Entity Type:Individual
Prefix:DR
First Name:FARIHA
Middle Name:BATOOL
Last Name:SULTAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:FARIHA
Other - Middle Name:BATOOL
Other - Last Name:KHAWAJA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:322 QUAIL HUNT RD
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29680-6590
Mailing Address - Country:US
Mailing Address - Phone:864-982-7365
Mailing Address - Fax:
Practice Address - Street 1:255 ENTERPRISE BLVD STE 101
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3530
Practice Address - Country:US
Practice Address - Phone:864-454-8120
Practice Address - Fax:864-454-8125
Is Sole Proprietor?:No
Enumeration Date:2014-01-07
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP8044207Q00000X
SC40423207QG0300X
GA92496207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC404235Medicaid