Provider Demographics
NPI:1669433215
Name:FARBOUDMANESCH, RAMIN (MD)
Entity type:Individual
Prefix:
First Name:RAMIN
Middle Name:
Last Name:FARBOUDMANESCH
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 1:1160 VARNUM ST NE
Mailing Address - Street 2:212
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-2107
Mailing Address - Country:US
Mailing Address - Phone:202-450-6081
Mailing Address - Fax:202-450-6084
Practice Address - Street 1:5454 WISCONSIN AVE
Practice Address - Street 2:1045
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-6901
Practice Address - Country:US
Practice Address - Phone:202-450-6081
Practice Address - Fax:202-450-6084
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DCMD33797207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC173470ZF1WMedicare PIN
F55384Medicare UPIN