Provider Demographics
NPI:1205894920
Name:FARAG, WAFAA Y (MD)
Entity type:Individual
Prefix:DR
First Name:WAFAA
Middle Name:Y
Last Name:FARAG
Suffix:
Gender:F
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:PO BOX 20669
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77225-0669
Mailing Address - Country:US
Mailing Address - Phone:713-790-0745
Mailing Address - Fax:713-790-1302
Practice Address - Street 1:7707 FANNIN ST
Practice Address - Street 2:SUITE 205
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-1926
Practice Address - Country:US
Practice Address - Phone:713-790-0745
Practice Address - Fax:713-790-1302
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL36382084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1501496-03Medicaid
TX150149602Medicaid
TX611189Medicare PIN
TX8F3041Medicare PIN