Provider Demographics
NPI:1932167004
Name:FARAHANY, HOSSEIN H (MD)
Entity Type:Individual
Prefix:DR
First Name:HOSSEIN
Middle Name:H
Last Name:FARAHANY
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 1:3626 LATROBE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-1183
Mailing Address - Country:US
Mailing Address - Phone:704-364-0057
Mailing Address - Fax:704-362-1611
Practice Address - Street 1:3626 LATROBE DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1183
Practice Address - Country:US
Practice Address - Phone:704-364-0057
Practice Address - Fax:704-362-1611
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23377207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC060067467OtherRAILROAD MEDICARE
SC443410Medicaid
NC8931139Medicaid
NC31139OtherBCBS
NC8931139Medicaid
NC060067467OtherRAILROAD MEDICARE