Provider Demographics
NPI:1982139481
Name:JAFARI, FARAMARZ (LAC DOM)
Entity Type:Individual
Prefix:DR
First Name:FARAMARZ
Middle Name:
Last Name:JAFARI
Suffix:
Gender:M
Credentials:LAC DOM
Other - Prefix:DR
Other - First Name:MARZ
Other - Middle Name:
Other - Last Name:JAFARI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC, DOM
Mailing Address - Street 1:5415 W CEDAR LN
Mailing Address - Street 2:204-B
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-1515
Mailing Address - Country:US
Mailing Address - Phone:301-523-5808
Mailing Address - Fax:
Practice Address - Street 1:5415 W CEDAR LN
Practice Address - Street 2:204-B
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-1515
Practice Address - Country:US
Practice Address - Phone:301-523-5808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-22
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02394171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist