Provider Demographics
NPI:1720053432
Name:AWAN, FARIDA N (MD)
Entity Type:Individual
Prefix:DR
First Name:FARIDA
Middle Name:N
Last Name:AWAN
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 82229
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36689-2229
Mailing Address - Country:US
Mailing Address - Phone:251-382-1878
Mailing Address - Fax:888-229-2558
Practice Address - Street 1:6701 AIRPORT BLVD STE B110
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-6775
Practice Address - Country:US
Practice Address - Phone:251-382-1878
Practice Address - Fax:251-706-2150
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL000169712080A0000X
ALMD.16971208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009942866Medicaid
AL009942866Medicaid