Provider Demographics
NPI:1780066431
Name:FANAIAN, FARAMARZ (DPM)
Entity type:Individual
Prefix:
First Name:FARAMARZ
Middle Name:
Last Name:FANAIAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 RHAWN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-2870
Mailing Address - Country:US
Mailing Address - Phone:215-742-1225
Mailing Address - Fax:215-742-3338
Practice Address - Street 1:1304 RHAWN ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-2870
Practice Address - Country:US
Practice Address - Phone:215-742-1225
Practice Address - Fax:215-742-3338
Is Sole Proprietor?:No
Enumeration Date:2015-06-18
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PASC006978213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program