Provider Demographics
NPI:1205683448
Name:FARHADI, FARAZ
Entity type:Individual
Prefix:
First Name:FARAZ
Middle Name:
Last Name:FARHADI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4135 FOUNTAINSIDE LN UNIT 301
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-7426
Mailing Address - Country:US
Mailing Address - Phone:703-901-1988
Mailing Address - Fax:
Practice Address - Street 1:833 PRINCETON AVE SW
Practice Address - Street 2:POB III SUITE 200-E
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35211-1323
Practice Address - Country:US
Practice Address - Phone:205-783-7663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-06
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program