Provider Demographics
NPI:1023692142
Name:FARAHNEH, OTHMAN HASAN OTHMAN (MD)
Entity type:Individual
Prefix:
First Name:OTHMAN
Middle Name:HASAN OTHMAN
Last Name:FARAHNEH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2810 W EXPRESSWAY 83
Mailing Address - Street 2:
Mailing Address - City:MERCEDES
Mailing Address - State:TX
Mailing Address - Zip Code:78570
Mailing Address - Country:US
Mailing Address - Phone:956-296-1916
Mailing Address - Fax:957-296-2970
Practice Address - Street 1:2810 W EXPRESSWAY 83
Practice Address - Street 2:
Practice Address - City:MERCEDES
Practice Address - State:TX
Practice Address - Zip Code:78570
Practice Address - Country:US
Practice Address - Phone:956-296-1916
Practice Address - Fax:957-296-2970
Is Sole Proprietor?:No
Enumeration Date:2021-05-06
Last Update Date:2022-06-09
Deactivation Date:2022-05-06
Deactivation Code:
Reactivation Date:2022-06-09
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program