Healthcare Provider Details

I. General information

NPI: 1457671000
Provider Name (Legal Business Name): SHOHEB A. FAROOQUI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2010
Last Update Date: 10/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4755 OGLETOWN STANTON RD CHRISTIANA HOSPITAL, DEPARTMENT OF RADIOLOGY
NEWARK DE
19718-2200
US

IV. Provider business mailing address

200 HYGEIA DR CCHS PHYSICIAN CONTACTING, SUITE 2300
NEWARK DE
19713-2049
US

V. Phone/Fax

Practice location:
  • Phone: 302-733-1806
  • Fax: 302-733-1808
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberC1-0011828
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD458830
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: