Provider Demographics
NPI:1831531227
Name:KADERIN, FARHANA
Entity type:Individual
Prefix:
First Name:FARHANA
Middle Name:
Last Name:KADERIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:FARHANA
Other - Middle Name:KARIM
Other - Last Name:KHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2279 SEVER RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-4028
Mailing Address - Country:US
Mailing Address - Phone:732-516-8019
Mailing Address - Fax:
Practice Address - Street 1:709 BREEDLOVE DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-2055
Practice Address - Country:US
Practice Address - Phone:732-516-8019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-25
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0745102084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY13-1624096OtherITIN