Healthcare Provider Details

I. General information

NPI: 1093962284
Provider Name (Legal Business Name): RASHNA FARHAD GINWALLA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2008
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1281 E IRON EAGLE DR
EAGLE ID
83616-6599
US

IV. Provider business mailing address

1775 W STATE ST PMB #361
BOISE ID
83702-3924
US

V. Phone/Fax

Practice location:
  • Phone: 208-985-6179
  • Fax:
Mailing address:
  • Phone: 208-900-8087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number229919
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberLT - 3446
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMT184794
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberD70894
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberM-15274
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: