Provider Demographics
NPI:1245254630
Name:FARHAD NASEH MD PA
Entity type:Organization
Organization Name:FARHAD NASEH MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:FARHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:NASEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-840-2208
Mailing Address - Street 1:6 MONTGOMERY VILLAGE AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-3530
Mailing Address - Country:US
Mailing Address - Phone:301-840-2208
Mailing Address - Fax:301-840-2210
Practice Address - Street 1:6 MONTGOMERY VILLAGE AVE STE 103
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-3530
Practice Address - Country:US
Practice Address - Phone:301-840-2208
Practice Address - Fax:301-840-2210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0050523207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG02199F01OtherMEDICARE INDVIDUAL #
MD400768900Medicaid
MDG02199Medicare ID - Type Unspecified
MDG02199Medicare PIN
MD6179780001Medicare NSC
MD400768900Medicaid