Basic Information
Provider Information
NPI: 1982993242
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FARAHANI
FirstName: FARIMAH
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 42472 MAGELLAN SQ
Address2:  
City: ASHBURN
State: VA
PostalCode: 201485607
CountryCode: US
TelephoneNumber: 7033143505
FaxNumber:  
Practice Location
Address1: 1906 BELLEVIEW AVE SE
Address2:  
City: ROANOKE
State: VA
PostalCode: 240141838
CountryCode: US
TelephoneNumber: 5409817000
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/07/2011
LastUpdateDate: 03/22/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/22/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 
207V00000X0102204197VAY Allopathic & Osteopathic PhysiciansObstetrics & Gynecology 

No ID Information.


Home