Healthcare Provider Details

I. General information

NPI: 1285690669
Provider Name (Legal Business Name): GHAZALA FARAH RAHMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 W CEDAR ST
PENSACOLA FL
32502-4910
US

IV. Provider business mailing address

PO BOX 4059
WAYNE NJ
07474-4059
US

V. Phone/Fax

Practice location:
  • Phone: 800-444-7009
  • Fax:
Mailing address:
  • Phone: 973-826-8291
  • Fax: 888-972-6480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036106974
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number205331-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD447749
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: